RESUMO
PURPOSE: To evaluate predictors of symptoms of gastroesophageal reflux disease (GERD) after sleeve gastrectomy (SG) based on a clinical questionnaire. MATERIALS AND METHODS: This is a cross-sectional study. We included all patients who underwent open SG between May 2013 and March 2017 in a single institution. Patients who could not be contacted or who did not want to participate were excluded. Clinical, demographic, and pre- and postoperative data were collected on medical records. Patients were contacted via telephone and inquired about GERD symptoms postoperatively. Symptoms were quantified using the GERD Questionnaire (GERDq). Patients were divided into three study groups according to GERDq score: asymptomatic (GERDq = 0), mildly symptomatic (GERDq ≤ 8), and severely symptomatic (GERDq > 8). Univariate analysis was performed using ANOVA, Kruskal-Wallis, Dunn, and chi-square tests. A logistic regression model was built for adjusted analysis of the data. RESULTS: One hundred eighty-nine patients were included. Mean age was 39.7 ± 10.71 years and 45.5% were female. Postoperative median follow-up period was 4.55 years (interquartile range 5.34-3.76). Mean GERDq score was 7.62 ± 10.17. Sixty-four patients were asymptomatic, 63 were mildly symptomatic, and 62 were severely symptomatic. The group of severely symptomatic patients showed a statistically lower preoperative weight when compared to the other groups (p = 0.049), but this association was not observed when analyzing preoperative BMI (p = 0.427). The other variables were not associated with postoperative GERD symptoms, both in univariate and adjusted analysis. CONCLUSION: No variables were statistically and clinically predictive of GERD occurrence or severity after SG. The pathophysiology of GERD is complex and further studies are needed to elucidate this condition.
Assuntos
Refluxo Gastroesofágico , Laparoscopia , Obesidade Mórbida , Adulto , Brasil/epidemiologia , Estudos Transversais , Feminino , Gastrectomia/efeitos adversos , Refluxo Gastroesofágico/epidemiologia , Refluxo Gastroesofágico/etiologia , Refluxo Gastroesofágico/cirurgia , Humanos , Pessoa de Meia-Idade , Obesidade Mórbida/cirurgia , Inquéritos e QuestionáriosRESUMO
RESUMEN Durante un procedimiento quirúrgico, ante una masa gástrica, el cirujano debe tomar la decisión de resecarla o posponer la cirugía (menor morbilidad), así como discutir con el equipo médico el mejor tratamiento. Los tumores mesenquimales gástricos que se encuentran durante la cirugía bariátrica son raros, especialmente el schwannoma gástrico (GS). Presentamos el caso de una mujer de 57 años, hipertensa y diabética en tratamiento, con un índice de masa corporal (IMC) de 36 kg/m², refiriendo dificultad para adelgazar con dieta y actividad física. La paciente fue sometida a un bypass gástrico Y de Roux con resección en cuña de un nódulo ubicado en la pared anterior de la escotadura angular. El análisis inmunohistoquímico fue fuertemente positivo para la proteína S100, mientras que c-kit (CD117), CD45, actina de músculo liso (SMA) y AE1/AE3 fueron negativos. El GS debe considerarse como un diagnóstico diferencial de los tumores gástricos. Presentamos una opción de tratamiento que le permite tratar a pacientes obesos con nódulos gástricos en cualquier lugar en el mismo procedimiento que la cirugía bariátrica.
RESUMO
abstract A 60-year-old woman was under investigation of dyspeptic symptoms. The upper gastrointestinal endoscopy showed a cystic subepithelial lesion in the second portion of the duodenum, measuring 8 mm in its longest diameter. The biopsy showed dilated Brunner's gland lobular ducts with scattered stromal elements, what characterized a Brunner's gland cyst. Brunner's gland cyst should be included in the differential diagnosis of gastrointestinal bleeding, dyspepsia, gastroesophageal reflux disease (GERD), malabsorption syndrome, anemia, among others. The correct nomenclature is important to facilitate research for articles specifically related to each duodenal cystic lesions and better understanding of these diseases, as some may have malignant potential.
resumen Paciente femenina, de 60 años de edad, tenía quejas dispépticas. La endoscopía digestiva reveló lesión subepitelial ubicada en la segunda porción del duodeno con aspecto quístico (signo de la tienda de campaña), de 8 mm en su mayor diámetro. Se realizó biopsia de la lesión. El análisis histopatológico mostró dilatación de los ductos lobulares de las glándulas de Brunner, acompañada por elementos estromales dispersos, identificando un quiste de las glándulas duodenales. Es un diagnóstico diferencial de sangrado intestinal, dispepsia, enfermedad por reflujo gastroesofágico (ERGE), malabsorción y anemia. La nomenclatura es importante tanto para buscar artículos específicos de cada lesión quística en el duodeno como para mejor caracterizar esas lesiones, puesto que algunas pueden tener potencial maligno.
resumo Paciente do sexo feminino, 60 anos, com queixas dispépticas. A endoscopia digestiva revelou lesão subepitelial localizada na segunda porção do duodeno com aspecto cístico (sinal da tenda positivo), de 8 mm no seu maior diâmetro. Biópsia da lesão foi realizada. A análise histopatológica mostrou dilatação dos ductos lobulares das glândulas de Brunner, acompanhada por elementos estromais dispersos, caracterizando um cisto da glândula de Brunner. É um diagnóstico diferencial de sangramento intestinal, dispepsia, doença do refluxo gastroesofágico (DRGE), má absorção e anemia. A nomenclatura é importante tanto para a pesquisa de artigos específicos de cada lesão cística no duodeno quanto para melhor caracterização dessas lesões, uma vez que algumas podem apresentar potencial maligno.