Study On The Effect Of Bariatric Surgery On Esophageal Function Of Obese Patients And Related Factors Of Postoperative Gastroesophageal Reflux Disease

Objective:Obese patients often have poor quality of life due to Gastroesophageal Reflux Disease(GERD).Weight loss metabolic surgery has become an effective treatment for morbid obesity.Whether GERD occurs after different weight loss methods is still controversial,which makes the choice of surgical procedures a key issue in clinical work.This study retrospectively analyzed the postoperative effects of laparoscopic sleeve gastrectomy and Roux-en-Y gastric bypass surgery under laparoscopic surgery,and the occurrence of gastroesophageal reflux symptoms after surgery,and the factors that may affect the symptoms of gastroesophageal reflux were analyzed.Methods:A total of 54 patients who underwent bariatric surgery in the First Affiliated Hospital of Dalian Medical University from January 2014 to January 2020 were included.They were divided into two groups: LSG and LRYGB according to the surgical procedure.Firstly,compare weight,body mass index(BMI),waist circumference change,percentage of excess weight loss(EWL%),and esophageal pressure of the overall patient before surgery,6 months after surgery,and 12 months after surgery.Compare the occurrence of diabetes,anxiety and depression,GERD,esophagitis before and after surgery.Secondly,compare the differences of the above-mentioned related data within and between the two surgical methods.Finally,the correlation between diabetes,depression and anxiety status,EWL% and GERDQ score in the LRYBG group was analyzed..Results:1.A total of 54 investigators were selected.The general preoperative data are as follows: age(38.5±12.0)years old,weight(107.4±26.3)Kg,BMI(37.6±8.2)Kg/m2,waist circumference(107.1±9.9)cm,esophagus Lower Esophageal Sphincter(LES)resting pressure is(18.0±7.8)mm Hg,LES residual pressure(4.6±5.0)mm Hg,preoperative Distal contractile integral(DCI)(2003.8±931.0);There were 48(88.9%)patients with diabetes before surgery,34(63%)patients with anxiety,4(7.4%)patients with depressive symptoms,18(33.3%)patients with GERD,11 patients with esophagitis(32.4%).Compared with 6 months after operation,there were significant differences in body weight,BMI,waist circumference,and diabetes status(P<0.05);In addition to the above indicators,there were significant differences in EWL%,anxiety,and depression at 12 months after surgery,but there was no statistical significance in the combined GERD and esophagitis(P>0.05).There was statistical significance in LES resting pressure before and after surgery(P<0.05),but there was no significant difference in LES residual pressure and DCI values.2.There were statistically significant differences in body weight,BMI,waist circumference,diabetes improvement,and anxiety state in the LSG group before and after surgery(P<0.05).There were also differences in these indicators between 6months and 12 months after surgery;and with GERD and esophagitis,there was no significant difference before and after the operation(P>0.05).The resting pressure of the patient’s LES before and after the operation increased,and the DCI value decreased after the operation,which was statistically significant(P<0.05).Except for esophagitis before and after the operation,other indicators in the LRYGB group were statistically significant.The postoperative LES resting pressure increased statistically(P<0.05),but in terms of body weight,BMI and waist circumference,there was no statistical difference between 6 months and 12 months after surgery(P>0.05).3.According to the surgical method,there are 39 cases in the LSG group and 15 cases in the LRYGB group.There was no significant difference in other indicators between the two groups before the operation except for the depression state(P<0.05).After the comparison between the two groups,there was a significant difference in the improvement of GERD symptoms(P<0.05).The improvement of GERD symptoms in the LRYGB group was significantly better than that in the LSG group.4.The correlation analysis between the preoperative diabetes,anxiety and depression patients in the LRYGB group and the postoperative GERDQ score was performed,and it was found that there was no significant correlation between the indicators;There was no significant correlation between postoperative EWL% and GERD score(P>0.05).Conclusion:1.Bariatric surgery can significantly reduce the weight of patients,alleviate or even cure diabetes,improve patients’ anxiety and depression,and effectively treat obesity.2.Bariatric surgery can increase the resting pressure of LES in obese patients after surgery,and may have a certain impact on the contractile function of the esophagus.3.There is no significant difference between the weight loss effect of the LSG group and the LRYGB group and the improvement of diabetes,anxiety and depression,but the weight loss effect of LRYGB is better.LRYGB can significantly improve the symptoms of GERD.The effect of LSG on GERD is still uncertain.The symptoms of acid reflux after LSG may be related to the changes in postoperative esophageal contractility,and further large sample studies are needed.4.Hyperglycemia and anxiety and depression may be related factors in obese patients with GERD,and the specific mechanism needs further study.