Combined 24-hour intraluminal pH and bile monitoring of the denervated whole stomach as an esophageal substitute.
OBJECTIVE
The study aims to evaluate the pH and the presence of bile in the denervated whole stomach pulled up to the neck after subtotal esophagectomy.


METHODS
The pH and the presence of bile in the gastric cavity were monitored by combined 24-hour pH and bilimetry in 16 patients having their whole stomach as an esophageal substitute (i.e., 8 with and 8 without a gastric drainage procedure) and in 25 healthy control subjects. The percentage of time during which pH was < 2 as well as the percentage of time during which bile absorbance was > 0.25 for the total, upright, and supine periods of recording were considered for each subject studied. Seven patients underwent a gastroscopy with biopsies.


RESULTS
Intragastric acidity was normal in 50% of patients while it was reduced in the other 50%. Ten of the 16 patients (62.5%), i.e., 4 with (50%) and 6 without (75%) a drainage procedure, had excessive exposure of the gastric mucosa to bile. No significant correlation was found between the existence of a high intraluminal pH profile and excessive bile exposure (p = 0.9163). Bile exposure was significantly higher in whole stomach patients than in controls in both the upright and supine positions, irrespective of the existence or absence of a drainage procedure (p ranging from 0.0272-0.0001). Bile exposure in the supine position tended to be longer in patients without than in those with a drainage procedure (p = 0.0929). Helicobacter pylori-negative chemical gastritis was present in 3 of the 7 patients who underwent a gastroscopy, all 3 having excessive bile exposure and no food retention in the transplant lumen.


CONCLUSIONS
Gastric denervation and transposition up to the neck increased exposure of the gastric mucosa to bile, irrespective of the patient's position and of the presence of a gastric drainage procedure. The absence of gastric drainage procedure tends to ensure exposure to bile prolongeLow gastric acidity, if present, is due to a reduction in acid secretion rather than to a buffering effect from duodenal juice having refluxed. Gastritis is more likely to be related to excessive exposure of the gastric mucosa to bile than to food retention.
Romagnoli
R
R
Department of Surgery, Louvain Medical School Hospital, Brussels, Belgium.
Bechi
P
P
Salizzoni
M
M
Collard
J M
JM
D000328:Adult; D000368:Aged; D001646:Bile / Q000737:chemistry*; D001655:Bile Reflux / Q000503:physiopathology; D003714:Denervation; D016629:Esophagectomy; D005260:Female; D005756:Gastritis / Q000503:physiopathology; D005773:Gastroscopy; D006801:Humans; D006863:Hydrogen-Ion Concentration; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic; D011184:Postoperative Period; D013270:Stomach / Q000737:chemistry* / Q000294:innervation / Q000637:transplantation*