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Preoperative physiological esophageal assessment for anti-reflux surgery:A guide for surgeons on high-resolution manometry and pH testing

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World Journal of Gastroenterology 2021年第16期27卷 1751-1769页

作者： Michael Yodice Alexandra Mignucci Virali Shah Christopher Ashley Micheal Tadros Department of Gastroenterology Albany Medical CollegeAlbanyNY 12208United States Section of Gastroenterology Stratton VA Medical CenterAlbanyNY 12208United States Department of Gastroenterology Albany Medical CenterSchenectadyNY 12309United States

Gastroesophageal reflux disease (GERD) is one of the most commonlyencountered digestive diseases in the world, with the prevalence continuing toincrease. Many patients are successfully treated with lifestyle modifications andproton pump inhibitor therapy, but a subset of patients require more aggressiveintervention for control of their symptoms. Surgical treatment with fundoplicationis a viable option for patients with GERD, as it attempts to improve the integrityof the lower esophageal sphincter (LES). While surgery can be as effective asmedical treatment, it can also be associated with side effects such as dysphagia,bloating, and abdominal pain. Therefore, a thorough pre-operative assessment iscrucial to select appropriate surgical candidates. Newer technologies arebecoming increasingly available to help clinicians identify patients with true LESdysfunction, such as pH-impedance studies and high-resolution manometry(HRM). Pre-operative evaluation should be aimed at confirming the diagnosis ofGERD, ruling out any major motility disorders, and selecting appropriate surgicalcandidates. HRM and pH testing are key tests to consider for patients with GERDlike symptoms, and the addition of provocative measures such as straight legraises and multiple rapid swallows to HRM protocol can assess the presence ofunderlying hiatal hernias and to test a patient’s peristaltic reserve prior tosurgery.

关键词： Gastroesophageal reflux disease Fundoplication High resolution manometry pH-impedance anti-reflux surgery Pre-operative assessment

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Metabolic changes in the lower esophageal sphincter influencing the result of anti-reflux surgical interventions in chronic gastroesophageal reflux disease

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World Journal of Gastroenterology 2005年第11期11卷 1623-1628页

作者： Aron Altorjay Arpad Juhasz Viola Kellner Gellert Sohar Matyas Fekete Istvan Sonar Department of surgery Central Clinical Laboratory Center for Advanced Biotechnology and Medicine UMDNJ

AIM: With the availability of a minimally invasive approach, anti-reflux surgery has recently experienced a renaissance as a cost-effective alternative to life-long medical treatment in patients with gastroesophageal reflux disease (GERD). We are not aware of the fact whether reflux episodes causing complaints for a long time i.e., at least for one year are associated with metabolic changes in the lower esophageal sphincter, and if so, whether these may influence functional results achieved after anti-reflux surgery. METHODS: Between 1 January 2001 and 31 December 2002 we performed anti-reflux surgery on 79 patients. Muscle samples were taken from the lower esophageal sphincter (LES) in 33 patients during anti-reflux surgery. Inclusion criteria were: LES resting pressure below 10 mmHg and a marked, pH proven acid exposure to the esophagus of at least one year's duration, causing subjective complaints and requiring continuous proton pump inhibitor treatment. Control samples were obtained from muscle tissue in the gastroesophageal junction that had been removed from 17 patients undergoing gastric or esophageal resection. Metabolic and lysosomal enzyme activities and special protein concentrations 16 parameters in total were evaluated in tissue taken from control specimens and tissue taken from patients with GERD. The biochemical parameters of these intra-operative biopsies were used to correlate the results of anti-reflux operations (Visick Ⅰ and Ⅱ-Ⅲ). RESULTS: In the reflux-type muscle, we found a significant increase of the energy-enzyme activities e.g., creatine kinase, lactate dehydrogenase, β-hydroxybutyrate dehydrogenase, and aspartate aminotransaminase-. The concentration of the structural protein S-100 and the myofibrillar protein troponin Ⅰ were also significantly increased. Among lysosomal enzymes, we found that the activities of cathepsin B, tripeptidyl-peptidase Ⅰ, dipeptidyl-peptidase Ⅱ, β-hexosaminidase B, β-mannosidase and β-galactosidase were significa

关键词： LES muscle Metabolic enzymes Lysosomal enzymes anti-reflux surgery Hypertrophy Dysphagia Gastroesophageal reflux

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Inflammatory responses in esophageal mucosa before and after laparoscopic antireflux surgery

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World Journal of Gastrointestinal surgery 2024年第3期16卷 871-881页

作者： Pelin Ergun Sezgi Kipcak Nur Selvi Gunel Eser Yildirim Sozmen Serhat Bor Department of Otolaryngology Medical College of WisconsinMilwaukeeWI 53226United States Division of Gastroenterology Ege UniversityFaculty of MedicineEge Reflux GroupIzmir 35100Turkiye Department of Medical Biology Ege UniversityFaculty of MedicineIzmir 35100Turkiye Department of Medical Biochemistry Ege UniversityFaculty of MedicineIzmir 35100Turkiye

BACKGROUND Currently,the primary treatment for gastroesophageal reflux is acid suppression with proton pump inhibitors,but they are not a cure,and some patients don’t respond well or refuse long-term ***,alternative therapies are needed to understand the disease and develop better *** anti-reflux surgery(LARS)can resolve symptoms of these patients and plays a significant role in evaluating esophageal healing after preventing harmful *** LARS improves typical gastroesophageal reflux symptoms in most patients,main-ly by reducing the exposure time to gastric contents in the ***-ration of the inflammatory response and a recovery response in the esophageal epithelium is expected following the cessation of the noxious *** To explore the role of inflammatory biomolecules in LARS and assess the time required for esophageal epithelial *** Of 22 patients with LARS(pre-and post/5.8±3.8 months after LARS)and 25 healthy controls(HCs)were *** subjects underwent 24-h multichannel intraluminal impedance-pH monitoring and upper gastrointestinal endoscopy,during which esophageal biopsy samples were collected using endoscopic *** molecules in esophageal biopsies were investigated by reverse transcription-polymerase chain reaction and multiplex-enzyme-linked immunosorbent *** Post-LARS samples showed significant increases in proinflammatory cytokines[interleukin(IL)-1β,interferon-γ,C-X-C chemokine ligand 2(CXCL2)],anti-inflammatory cytokines[CC chemokine ligand(CCL)11,CCL13,CCL17,CCL26,CCL1,CCL7,CCL8,CCL24,IL-4,IL-10],and homeostatic cytokines(CCL27,CCL20,CCL19,CCL23,C-CL25,CXCL12,migration inhibitory factor)compared to both HCs and pre-LARS ***17 and CCL21 levels were higher in pre-LARS than in HCs(P<0.05).The mRNA expression levels of AKT1,fibroblast growth factor 2,HRAS,and mitogen-activated protein kinase 4 were significantly decreased post-LARS vs pre-LARS.

关键词： anti-reflux surgery Gastroesophageal reflux disease Cytokine Inflammatory response Esophagus

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