The significance of the gastric secretory state in gastroesophageal reflux disease.
The gastric secretory status of 75 patients with abnormal esophageal exposure to gastric juice proved by 24-hour pH monitoring was measured to study the significance of gastric hypersecretion in gastroesophageal reflux disease. Gastric hypersecretion was a less-frequent finding than a mechanically defective sphincter (28% vs 72%, respectively). Forty-eight percent of patients with a normal sphincter, compared with 20% of those with a defective sphincter, were hypersecretors. In the presence of normal gastric secretion, complications occurred in 18% of those with a normal sphincter and 77% of those with a defective sphincter. In the presence of hypersecretion, the complication rate was 40% and 82%, respectively. These findings show that the development of reflux complications are related to a defective sphincter. Gastric hypersecretion in reflux patients with a normal sphincter is best treated by acid reduction using H2 blockers. Patients with a mechanically defective sphincter, regardless of their gastric secretory state, should have an antireflux procedure.
Department of Surgery, Creighton University School of Medicine, Omaha, Neb. 68131.
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Barlow
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DeMeester
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Ball
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Eypasch
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004943:Esophagogastric Junction / Q000503:physiopathology; D004947:Esophagus / Q000378:metabolism; D005260:Female; D005744:Gastric Acid / Q000378:metabolism*; D005764:Gastroesophageal Reflux / Q000150:complications / Q000378:metabolism* / Q000503:physiopathology; D006801:Humans; D006863:Hydrogen-Ion Concentration; D008297:Male; D008365:Manometry; D008875:Middle Aged