Objective To review the clinical experience of Heller myotomy for treatment of achalasia through a small thoracotomy. Methods Twenty-five patients with achalasia (9 moderate, 16 severe) underwent Heller myotomy without concomitant antireflux procedure through a small incision. A left thoracotomy was carried out through either the seventh or eighth intercostals space. The length of skin incision was 6 to 8 cm. Results There was no hospital death and severe postoperative complications. The mean operating time was 50 minutes. Mean hospital stay was 10 days. There was one intraoperative perforation and repaired successfully. All patients reported good to excellent relief of dysphagia and no symptom of gastroesophageal reflux after surgery. Eight patients were subsequently studied with a 24-hour esophageal pH monitoring and no evidence of pathologic reflux found. Conclusions Transthoracic Heller myotomy with a small incision is effective and safe method for treatment of achalasia with minimal invasion, quick recovery, less postoperative complication and shorter hospital stay. Proper extent of the myotomy may decrease the risk of subsequent gastroesophageal reflux in the postoperative period.
Abstract: Objective To evaluate the effect on gastroesophageal reflux and gastric emptying in the different route of gastroesophageal anastomosis objectively after esophagectomy for patients with midesophageal carcinoma. Methods Forty patients with midesophageal carcinoma were randomly divided into two groups. Esophageal bed group (n=20): the gastroesophageal anastomosis were performed while the stomach were pulled on through the esophageal bed after esophagectomy; endothoracic group (n=20): gastroesophageal anastomosis were performed while the stomach were pulled on in the thoracic cavity. Ten persons had no disease of digestive system and healthy volunteers were recruited as normal control group. 24-hour esophageal pH monitoring and radioisotope gastric emptying checkup were carried out in all experimental subjects 3 months after operation, so as to observe the changes of gastroesophageal reflux and gastric emptying. Results All of the patients’s operation were success. And no anastomotic leakage and no anastomotic stenosis. Three months after operation, the patients in both operation groups were with different level of reflux. DeMeester total appraise score, the times of regurgitation of gastric juice in 24h, gt;5 min reflux frequency, the longest time of keep reflux, pHlt;4.00 total time and pHlt;4.00 of total time percent, these targets in both operation groups were higher than those in control group (Plt;0.01) DeMeester total appraise score, the times of regurgitation of gastric juice in 24 hours, the longest time of keeping reflux, pHlt;4.00 of total time and pHlt;4.00 of total time percent in esophageal bed group were lower than those in endothoracic group(Plt;0.01). The recent period of gastric emptying percentage (GE) in both operative groups were lower than that in normal control group. GE in esophageal bed group experimental meal in the stomach after entering the 30,60,90,120,180 and 240 min were higher than those in endothoracic group. Conclusion After the operation of esophagogastric anastomosis through esophageal bed in upper aortic site,gastroesophageal reflux and delayed gastric emptying exist objectively, However, the technique is superior to the traditional technique to reduce the extent of gastroesophageal reflux and delayed gastric emptying, its mechanism might be the result of mechanical factors.
ObjectiveTo present the safety and efficiency of laparoscopic Nissen fundoplication for hiatal hernia in elderly patients.
MethodsClinical data of 35 elderly patients with hiatal hernia who underwent laparoscopic Nissen fundoplication in The Affiliated Hospital of Xuzhou Medical College between August 2013 and March 2014 was retrospectively analyzed.
ResultsAll patients underwent laparoscopic Nissen fundoplication. The operation time was 72-minute in average (65-105 minutes) and intraoperative blood loss was 30 mL in average (10-120 mL). The mean value of postoperative hospital stay was 5-day (3-23 days). Patients' stomachs and esophagus were restored to normal position after surgery. No complication was noted except 2 patients had mild gastroesophageal reflux after operation, and 1 patient suffered from transient dysphagia after operation, all the symptoms subsided after conservative treatment. Afterwards, 33 of them achieved follow-up for 6 to 12 months (mean of 8.5 months), the other 2 patients were lost to follow-up. During the follow-up period, a questionnaire regarding to the criteria for Reflux Diagnostic Questionnaire (RDQ) score were conducted in the 33 patients, and the results showed that the symptoms including acid reflux, heartburn, chest pain, cough, dyspnea, lump sensation in the pharynx, and hoarseness were improved significantly in 6 months after operation (P<0.05), and no recurrence was found during the follow-up period.
ConclusionLaparoscopic Nissen fundoplication is a safe operation for elderly patients with hiatal hernia, and it can achieve good clinical result.
Objective We aimed to evaluate the prevalence of H.pylori infection and the prevalence of cagA+ strains in patients with and without Barrett’s esophagus. Methods A full literature search to February 2008 was conducted in PubMed, MEDLINE and EMbase databases to identify case-control studies or cohort studies evaluating the prevalence of H.pylori in patients with or without Barrett’s esophagus. Summary odds ratios (OR) and 95% confidence interval (CI) were calculated by RevMan 4.2.8. Results Nineteen studies were identified (16 case-controlled studies and 3 cohort studies). In case controlled studies, the prevalence of H.pylori infection significantly decreased in patients with Barrett’s esophagus as compared subjects with normal endoscopic appearance, with a overall OR of 0.56 (95%CI 0.40 to 0.79). The prevalence of H.pylori infection was no statistically significant difference in patients with Barrett’s esophagus as compared to those with gastroesophageal reflux disease, with a overall OR of 0.86 (95% CI 0.74 to 1.00). In cohort studies, the prevalence of H. pylori was no statistically significant difference in patients with Barrett’s esophagus as compared to patients with normal endoscopic appearance or patients with gastroesophageal reflux disease, with a overall OR of 1.12 (95%CI 0.77 to 1.61) and 1.10 (95%CI 0.32 to 3.83). When the analysis was stratified by the status of cagA, the prevalence of cagA positive strains significantly decreased in patients with Barrett’s esophagus as compared both to subjects with normal endoscopic appearance with OR 0.30 and 95% CI 0.12 to 0.74, and to those with gastroesophageal reflux disease (OR 0.55; 95%CI 0.33 to 0.94). Irrespective of the presence of intestinal metaplasia, similar magnitude for the reduction of H.pylori infection was observed for patients with Barrett’s esophagus and those with normal endoscopic appearance. While accompared with the presence of intestinal metaplasia, Barrett’s esophagus was associated with a significantly reduction as compared to the patients with gastroesophageal reflux disease (OR 0.81, 95%CI 0.68 to 0.98). When stratified analyses were performed, a significant reduction of H.pylori infection was observed only in patients with long-segment Barrett’s esophagus (OR 0.54; 95%CI 0.35 to 0.82), but not in those with short-segment Barrett’s esophagus (OR 0.72; 95%CI 0.43 to 1.20). Conclusion This meta-analysis indicated that the prevalence of H.pylori infection, especially the prevalence of cagA positive strains was significantly lower in patients with Barrett’s esophagus than in subjects with normal endoscopic appearance. However, the prevalence of H. pylori infection was no statistical difference in patients with Barrett’s esophagus as compared to those with gastroesophageal reflux disease. Colonization with cagA positive strains may be protective against the formation of Barrett’s esophagus.
ObjectiveTo investigate the individualized management of severe gastroesophageal reflux disease (GERD) secondary to scleroderma, particularly the safety and feasibility of laparoscopic Toupet fundoplication for this entity.
MethodsFrom June, 2011 to June, 2014 six inpatient cases had severe GERD secondary to scleroderma were documented. Endoscopy, esophageal high-resolution manometry and 24 hours reflux monitoring were applied for GERD evaluation. Maintenance of conservative treatment was carried out for the 2 cases who responsed well to medication therapy, laparoscopic Toupet fundoplication was done for the 4 cases who had extraesophageal symptom and not well controlled by medication. The patients were followed-up for an average of 2.2 years (1 to 4 years) after discharge, and endoscopic was rechecked during the followed-up.
ResultsThe esophageal symptom of regurgitation, heartburn and dysphagia, as well as the extraesophageal symptom of cough and asthma significantly relieved during followed-up, meanwhile the anti-reflux medication was reduced or stopped in all the patients. For the 4 surgical patient, one had partial recurrence and no complication occurred.
ConclusionsThe management of severe GERD secondary to scleroderma could follow the strategy of controlling the primary disease, living adjustment, anti-reflux medication and surgery step by step. The laparoscopic Toupet fundoplication may be safe, effective and feasible for the medication unmet patients, it deserves further studies.
Objective
To investigate the gastrin level in patients with type 2 diabetes mellitus (T2DM) with gastroesophageal reflux disease (GERD), and analyze the possible mechanism of gastrin in the pathogenesis of T2DM combined with GERD.
Methods
Thirty-eight patients with T2DM combined with GERD treated between January 2013 and January 2015 were designated as group A; 40 patients with T2DM only were regarded as group B; 36 patients with GERD only were regarded as group C; and another 40 healthy volunteers who underwent physical examination at the same period were regarded as group D. The fasting serum levels of gastrin were measured and compared among the above four groups.
Results
The fasting serum level of gastrin was significantly higher in group A [(116.53±22.02) pg/mL] than group B [(101.89±20.76) pg/mL], group C [(90.04±21.16) pg/mL], and group D [(92.48±19.69) pg/mL] (P<0.01). The fasting serum level of gastrin in group B was significantly higher than group C and D (P<0.05). There was no significant difference between group C and D in terms of fasting serum level of gastrin (P>0.05).
Conclusions
There is a high level of gastrin in patients with GERD combined with T2DM. Abnormal secretion of gastrin may be closely related with the occurrence and development of T2DM and GERD.
ObjectiveTo summarize basic research progress and current status of clinical diagnosis and therapy for gastroesophageal reflux disease.
MethodRelated literatures were collected to review the pathogenesis, clinical manifestations, diagnosis and therapy of gastroesophageal reflux disease.
ResultsGastroesophageal reflux disease was caused by many factors, such as hiatus hernia, hypotensive lower esophageal sphincter pressure, acid pocket, prolonged esophageal clearance, and delayed gastric emptying. Extra-esophageal symptoms was a common clinical presentation to gastroesophageal reflux disease. The diagnosis methods for gastroesophageal reflux disease included the symptom observation, gastroscopy examination, 24 h pH monitoring of esophageal, proton pump inhibitor test, questionnaire of gastroesophageal reflux disease and so on. The laparoscopic fundoplication could essentially treat the pathophysiologic abnormalities of gastroesophageal reflux disease, which had an obvious curative effect and wide application prospect.
ConclusionPathogenesis, diagnosis, and therapy of gastroesophageal reflux disease are associated with multiple factors, which is still controversial and remains to be further studied.
Objective To compare the short-term curative results between Nissen, Thal and Toupet fundoplications in treatment of gastroesophageal reflux(GER) and to provide the basis for operative procedure. Methods Thirty-three male Japan rabbits were randomly divided into six groups: group reflux(n=7), transabdominal Heller’s esophagomyotomy (TAHE)；group Nissen(n=7)，TAHE and Nissen fundoplication；group Thal(n=7)，TAHE and Thal fundoplication；group Toupet(n=7)，TAHE and Toupet fundoplication； control group (n=5)，ventrotomy. The anti-reflux efficacy of fundoplication was evaluated by intraesophageal pH monitoring and MGV（maximal gastric volume sustained by lower esophageal sphincter）4 weeks postoperatively. Results ① The total number of reflux episodes and the reflux ratio（0.83±0.41,2.20%±1.12%） of group Nissen were significantly lower than those of group Thal (2.20±0.45, 4.32%±0.82%) and group Toupet (1.80±0.45, 4.20%±0.57%), respectively (Plt;0.05). ② MGV of group Nissen (233.00±9.44)ml was significantly larger than those of group Thal （203.40±11.13）ml and group Toupet（197.60±10.99）ml, respectively (Plt;0.05). ③There were no significant difference in total number of reflux episodes, reflux ratio and MGV between group Thal and group Toupet (Pgt;0.05).Conclusion Nissen fundoplication was better than Thal and Toupet fundoplications,Thal and Toupet fundoplications are similar in short-term curative result.
ObjectiveTo investigate the clinical effects of laparoscopic hiatus reconstruction with Bard Crurosoft patch associated with Nissen fundoplication in elderly patients with gastroesophageal reflux disease (GERD). MethodsFrom July 2006 to July 2009, 22 consecutive elderly patients （≥65 years） with GERD underwent laparoscopic hiatus reconstruction associated with Nissen fundoplication， 10 of them underwent laparoscopic Crurosoft patch hiatus reconstruction (hiatus diameter≥5 cm in 2 patients， lt;5 cm in 8 patients) and 12 underwent laparoscopic simple sutured hiatus reconstruction (hiatus diameter≥5 cm in 2 patients， lt;5 cm in 10 patients). Intra and perioperative data including symptoms (heartburn, regurgitation, dysphagia, and respiratory complications), functional evaluations (esophagogastroscopy, manometric evaluations in lower esophageal segment, and 24 h pH-monitoring values) were compared and analyzed. ResultsPatients in 2 groups had similar preoperative values in demographics, symptom scores, functional evaluations, as well as operative data except for mean operative time. Three-month and 1-year follow-up after operation, the results of symptoms scores and functional evaluations of patients in 2 groups compared with preoperative values wear improved （Plt;0.05）, but symptoms scores and functional evaluations of patients in patch group were evaluated to demonstrate more significant improvement than suture group （Plt;0.05）. In suture group, the results of 3 months after operation were better than 1 year after operation, with statistically significant difference （Plt;0.05）. Two patients underwent postoperative intrathoracic immigration of wrap in suture group, but this complication did not happen in patch group （Plt;0.05）. ConclusionsLaparoscopic hiatus reconstruction with Bard Crurosoft patch associated with Nissen fundoplication is a safe and effective treatment for elderly patients(≥65 years) with GERD.
Objective To investigate the prevalence and predisposing factors of gastroesophageal reflux（GER）in patients with chronic obstructive pulmonary disease（COPD）and its impacts on the frequency of COPD exacerbations.Methods 50 patients with acute exacerbation of COPD were enrolled in the study.All patients filled a modified version of clinically validated standardized Mayo Clinic GER questionnaire.Pulmonary function tests（PFT），body mass index（BMI），serum albumin，and medications were recorded.The patients were divided in to GER group（13 patients with GER symptoms longer than one year and diagnosed GER by gastroscope） and non-GER group（37 patients without GER symptoms）.Results There were no significant differences in the BMI，serum albumin，use of inhaled steroids and theophylline between the two groups.Forced expiratory volume in one second as a percentage of the predicted value（FEV1%pred）（37% vs 38.3%，P=0.608.），residual volume % predicted（123.4 % vs 137.8%，P=0.222），and residual volume to total lung capacity（139.4% vs 141.5%，P=0.798） were not significantly different between the two groups.The number of COPD exacerbations per year was significantly higher in patients with GER compared to patients without GER（4.5 vs 1.3，P=0.006）.Conclusions The severity of airflow obstruction and the hyperinflation is unlikely to contribute to the development of GER.Patients with GER experience significantly more exacerbations per year when compared to patients without GER，suggesting more highlight warrant in treatment of GER in COPD patients.
