PubMed · 15770872
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G Tijtgat. 2004. [GERD pathogenesis].. https://pubmed.ncbi.nlm.nih.gov/15770872/
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KEEP EXPLORING
Difficulties of initiating or maintaining sleep are very common in the general population. Individuals with clinical sleep disorders have a greatly impaired quality of life. The causes for sleeping disorders are complex, but evidence has recently come from different trials supporting a causal relationship between gastro-esophageal reflux disease (GERD) and sleep disorders in some patients. The majority of patients with GERD report reflux symptoms during the night. It is well known that especially at night reflux is characterized by prolonged esophageal acid exposure. Recent data have indicated that sleep disorders significantly improve while on efficacious antisecretory treatment. In particular in patients with sleep disorders but no previously known GERD, the search for it is recommended and should be followed by adequate antisecretory treatment. In other severe diseases associated with sleep, like the obstructive sleep apnoea syndrome (OSAS), an association with esophageal acid exposure has been proven. The sleep apnea-associated reflux has probably a multifactorial etiology: in cases with other predisposing conditions for gastro-esophageal reflux, OSAS promotes the development of reflux. Antisecretory treatment has been able to improve the severity of OSAS. The purpose of this review has been to survey of recent publications in GERD-associated sleep disorders, as well as the possible pathophysiological basis of the observed phenomena.
BACKGROUND: This study aimed to evaluate the development and outcomes of laparoscopic antireflux surgery in Germany using a nationwide representative survey. METHODS: A written questionnaire including 34 detailed questions and 288 structured items about diagnostic and therapeutic approaches, number of procedures, complications, and mortality was sent to 546 randomly selected German surgeons (33% of the registered general surgeons) at the end of 2000. RESULTS: The response rate was 72%, and a total of 2,540 antireflux procedures were reported. According to the survey, 81% of all procedures were performed laparoscopically, and 0.1% were performed thoracoscopically. As reported, 65% were total fundoplications, 31% were partial fundoplications, and 4% were other procedures. Of the surgeons who had experience with laparoscopic antireflux techniques (29%), 71% preferred a 5-trocar technique, and 91% used the Harmonic Scalpel for dissection. There were significant technical variations among the surgical procedures (e.g., use and size of the bougie, length of the wrap, additional gastropexy, fixation of the wrap). The overall complication rate for laparoscopic fundoplication was 7.7% (5.7% surgical and 2% nonsurgical complications), including rates of 0.6% for esophageal perforations and 0.6% for splenic lesions. The conversion rate was 2.9%; the reoperation rate was 1.6%; and the overall hospital mortality rate was 0.13%. The authors observed a striking learning curve difference in complication rates between hospitals performing fewer than 10 laparoscopic antireflux techniques annually and those performing more than 10 fundoplications per year (14% vs 5.1%, p < 0.001). Long-term dysphagia and interventions occasioned by dysphagia occurred significantly more often after total fundoplications than after partial fundoplications (6.6% vs 2.4%; p < 0.001). Similar findings were reported for Nissen versus floppy Nissen procedures. The overall failure rate, however, was similar for both groups (Nissen 8.7%; partial 9%, difference not significant). CONCLUSIONS: Until now, no unique laparoscopic antireflux technique has been accepted, and a number of different antireflux procedures with numerous modifications have been reported. The morbidity and mortality rates reported in this article compare very well with those in the literature, and 1-year-follow-up results are promising.
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