PDF (5 MB) - Jurnalul de Chirurgie

158 Mocanu MA. et al.Jurnalul de Chirurgie (Iaşi), 2013, Vol. 9, Nr. 2reflux and if the duodenogastric reflux canaggravate GERD.MATERIAL AND METHODSWe retrospectively reviewed 59patients with GERD. Different data(demographic, GERD severity, duodenogastricreflux, gallbladder ejection fraction,duodenal motility) were analysed.The diagnosis of GERD was doneusing clinical data and upper endoscopyexamination. The duodenogastric reflux wasalso proved by upper digestive endoscopy(bile inside the stomach).The abdominal ultrasound examinationwas used to diagnose the gallbladderdiseases and to evaluate the gallbladdermotility; in this way we calculatedgallbladder volume (V) using the formulaV = 0.5 x L x l x g where L is the gallbladderlength, l is the width of gallbladder and g isthe thickness of gallbladder wall [3]. Theejection fraction (EF) was then calculatedusing the formula EF = V 1 -V 2 / V 1 x 100were V 1 is the fasting gallbladder volumeand V 2 is the volume after the ingestion ofBoyden meal. Normal EF values are 50 to60%; the cases with higher values werenoted as „hyperkinesia”. The duodenalmotility was also evaluated using abdominalultrasound exam and it was noted as„normal” or „increased”.In order to evaluate the GERD wecalculated the GERD Q-score [4-6]. The Q-score contains 6 questions: 4 items aboutsymptoms and 2 items about the impact ofsymptoms on the patient’s life (health relatedquality of life) (Table I). The answers arefilled in by the patient and than evaluated bythe doctor. The total score was calculated byadding the point values for eachcorresponding answer. Increasing scorescorrelated with GERD severity (Table I).Data were included in a MS Exceldatabase and statistically analyzed; bivariateanalysis (t test and χ 2 test) was used. AP < 0.05 was considered statisticallysignificant.Table I GERD Q score questionnaire [4]Symptoms and health related quality of life (HQLR)How often have you had burning sensation in the chest(heatburn) ?How often have you felt food or liqiud stomach contentsturning it in the mouth or throat (regurgitation) ?How often have you had pain in the upper abdomenum(epigastric pain) ?How many times does this occur per week?0 Days 1 Day 2 to 3 Days 4 to 7 Days0 p 1 p 2 p 3 p0 p 1 p 2 p 3 p3 p 2 p 1 p 0 pHow often have you had nausea ? 3 p 2 p 1 p 0 pHow often have you had trouble sleeping due toheartburn or regurgitation ? (HQLR - item)How often have you taken medication for heartburn andregurgitation further other than those prescribed by adoctor (ranitidine, maalox, dicarbocalm) (HQLR - item)0 p 1 p 2 p 3 p0 p 1 p 2 p 3 pThe total score is interpretated as follows: 0 to 2: no probability of GERD; 3 to 7: Low probability of GERD (50% likelihood of GERD);8 to 10: GERD (discomfort ± disturbing symptoms); 11 to 18: severe GERD (discomfort ± disturbing symptoms)RESULTSThe women to men ratio was 30 to29 and the mean age was 42 ±2 years.Cholesterolosis was found in 45.7%(n=27) from the patients; 54.3% (n=32) didnot have any gallbladder diseases. From thepatients with cholesterolosis, 92.6% (n=25)had a ejection fraction (EF) above normal(hyperkinesia) and only two patients hadnormal gallbladder motility (EF 50 to 60%).From the patients with cholesterolosis,twenty (74%), had duodenogastric reflux.The other 32 patients without cholesterolosishad no duodeno-gastric reflux neither.We noted a strong statisticalcorrelation between the cholesterolosis and