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Query: UMLS:C0017168 (gastroesophageal reflux disease)
 11,783 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Herein we describe two patients with medically refractory, severe reflux esophagitis after vertical banded gastroplasty for morbid obesity. Neither patient had symptoms of reflux preoperatively. Both patients underwent conversion to a vertical Roux-en-Y gastric bypass, an operation that prevents acid and peptic reflux and maintains a weight-reducing anatomy. Symptoms of gastroesophageal reflux are common (they occur in approximately 38% of patients) after vertical banded gastroplasty has been performed. Patients with unusually severe reflux may require operative management.
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PMID:Severe reflux esophagitis after vertical banded gastroplasty for treatment of morbid obesity. 173 88

The Willmen gastric bubble has been used as an adjunct to weight loss in morbidly obese patients. 35 patients with morbid obesity were studied with routine manometry, esophageal 24-h-pH-measurement, and gastric emptying studies before and 4 weeks after bubble placement. During emptying studies blood samples were taken to measure gastrin, PP, CCK, VIP, neurotensin and insulin. No patient developed heartburn or regurgitation after bubble placement. Esophageal motility and LES function remained unchanged. There was no important pathological gastroesophageal reflux before and after gastric bubble. The gastric emptying time of solid food was unchanged by gastric bubble placement and the emptying time of liquids was accelerated up to normal. In patients with fasting gastrin levels less than 20 pg/ml at the beginning of the first test we found no differences in gastrin release before and after bubble insertion. In patients with primary high fasting values gastrin release was significantly increased. CCK, VIP, neurotensin and insulin levels were unchanged. With PP we measured significantly raised fasting levels after gastric bubble. We conclude that esophageal and LES functions are not altered by Willmen gastric bubble placement and that primary retardation of fluids is changed to normal. Bubble induced gastric tension increases fasting PP. In case of high fasting gastrin the bubble leads to an extremely high food response without any clinical signs.
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PMID:[Does the stomach balloon modify the function of the esophagus and lower esophageal sphincter, stomach emptying and release of gastrointestinal peptides?]. 266 61

Several gastric operations have been developed for the control of morbid obesity. Further surgical intervention may be necessary because of failure to lose weight or complications associated with the previous operation such as intolerable reflux symptoms. Revision from a horizontal to a vertical staple line may result in a stenosis at the site of the gastro-gastrostomy. This study examines the authors' experience with balloon dilation of these strictures. Between May, 1981 and September, 1987, 12 of 113 patients who had revision of previous gastric reduction procedures developed either gastro-gastrostomy stenosis or stenosis above the Marlex collar (2 patients). Endoscopic balloon dilatation was attempted in all 12 patients. Eight females and four males (average age, 42 years) had undergone either a previous vertical banded gastroplasty (VBG) (2 patients), gastric bypass, or horizontal gastroplasty as their initial operation. Revision was performed for failure of the initial operation to control weight, obstructive symptoms, or gastroesophageal reflux. Balloon dilatation was possible in 11 of 12 patients. The majority required less than four dilations to alleviate obstructive symptoms. Balloon dilatation is effective in the management of gastro-gastrostomy stenosis following revision of gastric stapling procedures.
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PMID:Balloon dilatation of gastro-gastrostomy strictures in gastroplasty revisions. 291 98

Gastroplasty aimed at treatment of morbid obesity creates a small proximal pouch and a narrow stoma to the remainder of the stomach. In 11 consecutive obese patients subjected to gastroplasty radiologic examinations of the stomach were performed before operation and one week, 3 and 12 months postoperatively. All stomachs were normal before operation. A significant decrease in pouch area and increase in stoma diameter were registered over the observation period. There were no statistically significant correlations between postoperative weight loss and stoma diameter or pouch area. Nor was retention in the pouch one week after gastroplasty related to weight loss. Radiographic evidence of gastroesophageal reflux was present in only one patient. The described method of follow-up is evidently not suited to predict the outcome of gastroplasty.
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PMID:Radiologic findings and weight loss following gastroplasty for morbid obesity. 379 27

Since 1976, in 100 morbidly obese patients, the lesser curvature of the stomach has been inverted by performing a Nissen's fundoplication followed by gastric wrapping. All but one are losing weight satisfactorily and have early satiety. There was one postoperative death from pulmonary embolus. No harmful metabolic or physiologic changes have been detected. This procedure corrects or prevents esophageal reflux and enables the patient to control morbid obesity.
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PMID:Gastric (reservoir) reduction for morbid obesity. 723 51

Despite new effective drugs, like omeprazole, reducing gastric acid output and relieving gastro-oesophageal reflux disease (GERD) symptoms in most patients, there are still clear indications for surgical treatment of this chronic disease. The main indications are failure to control symptoms by medical treatment, noncompliance to medication and development of complications. Recent developments in minimal access surgery have modified the surgical approach to the treatment of GERD. The antireflux surgical procedures can be endoscopically performed reproducing all the essential component steps of the equivalent open operations, but with all the advantages of minimal access surgery. The fundoplication procedures are mainly performed laparoscopically and the thoracoscopic approach is chosen in patients with short oesophagus, morbid obesity or other contraindications to the laparoscopic approach. The short-term results of endoscopic antireflux surgery are at least as good than after open surgery. A review on the laparoscopic and thoracoscopic antireflux procedures is presented.
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PMID:Laparoscopic and thoracoscopic antireflux surgery. 757 70

Three years experience of laparoscopic surgery for treatment of gastroesophageal reflux, large paraesophageal hernia and morbid obesity is presented. One hundred and thirty-six patients with reflux esophagitis and 6 patients with large paraesophageal or combined hiatal hernias have been laparoscopically treated with hiatal hernias have been laparoscopically treated with hiatal hernia repair and a 360 degrees Rosetti (N = 109) or semitotal Toupet (N = 33) fundoplication. Sixteen patients with morbid obesity have been treated with laparoscopic placement of a variable band around the cardia. Twelve months follow-up is available for 74 of the esophageal reflux patients. 90% of the patients are completely satisfied. One patient has been reoperated due to recurrent reflux and one due to hiatal fibrosis. The cardia banded patients achieved the desired dysphagia to control food intake. Complication rates are low in all groups. Laparoscopic fundoplication, closure of large hiatal defects and cardia banding are feasible with low morbidity and comparable outcome to open surgery. Further studies are needed to investigate to what extent the laparoscopic technique is beneficial to the patient and cost effective.
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PMID:Laparoscopy in the gastroesophageal junction. 874 Jun 74

Morbid obesity is related to a severe decrease in life expectancy. No medical or dietary treatment offers an alternative to control hypertension, apnea syndrome, orthopedic diseases, ..., caused by overweight. With respect to a serious preoperative evaluation and a severe selection (psychologic, dietetic, ...) Silastic Ring Vertical Gastroplasty is considered in our experience (more than 300 cases) and in the literature as the gold standard for surgical treatment of obesity. The long term follow-up (24-66 months) of 100 consecutive operated patients shows a positive response on hypertension (96%), apnea syndrome (92%), diabetes (85%), gastroesophageal reflux (76%), orthopedic diseases (74%) and cardiorespiratory insufficiency (74%). Considering our experience in the medical and surgical management of patients operated in our department or referred from other centers for complications after different procedures, we actually propose SRVG as the treatment of choice for morbid obesity.
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PMID:[The treatment of morbid obesity with gastroplasty]. 892 52

In industrialized countries, surgical gastroplasty is performed more and more frequently in patients with morbid obesity. The aims of this prospective study were to determine the incidence of upper gastrointestinal lesions in obese patients and to assess the place of digestive endoscopy in symptomatic patients after gastroplasty. A consecutive group of 159 obese patients were studied before and after vertical banded gastroplasty. In the preoperative evaluation, reflux esophagitis and gastroduodenal lesions were endoscopically observed in 31% and 37% of the patients, respectively. Interestingly, the majority of the obese patients with upper gastrointestinal lesions were asymptomatic. In the postoperative follow-up period, 55 of the 159 patients complained of upper gastrointestinal symptoms such as vomiting (72%), esophageal reflux (17%), and epigastric pain (3%). Stenosis of the outlet of the gastric pouch was described in 40 of the 55 symptomatic patients. Esophagitis was observed in 60% of these patients. Endoscopic dilation using Savary bougies or TTS balloon was successfully performed in all the patients with symptomatic stenosis of the gastric outlet. Food impaction was endoscopically removed in four patients. Thus, we recommend performing an upper gastrointestinal endoscopy in obese patients who are candidates for surgical gastroplasty because of the high incidence of upper gastrointestinal peptic lesions. Endoscopy is also helpful in patients with digestive disorders occurring after gastroplasty in order to define and to treat the lesions.
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PMID:The place of upper gastrointestinal tract endoscopy before and after vertical banded gastroplasty for morbid obesity. 939 14

Bariatrics surgery has been a subject to a noteworthy revolution since the advent of the laparoscopic approach. This overview of the literature highlights on established scientific data in this field and the eventual evidence bases of laparoscopic surgery. Vertical banded gastroplasty and gastric bypass are now recognised as the gold-standards for the surgical treatment of morbid obesity by laparotomy. For the minimally invasive approach, the gastric banding appears now as a validated technique with a good level of evidence. The results of this approach appears to be comparable to those of other techniques (in terms of weight loss). But there is at present no randomized trial comparing the gastric banding with the gold-standards (gastric banding versus vertical banded gastroplasty). Some particular feature of this surgery are discussed (such as the association of a gastroesophageal reflux disease or a cholelithiasis). The criteria of patient's selection, the pre and post-operative management are also detailed in the light of literature data and guidelines of international societies.
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PMID:[Laparoscopic surgery for obesity]. 1061 84


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