title: Evaluation of gastroesophageal reflux disease following various reconstructive procedures for a distal gastrectomy.
abstract: OBJECTIVE
  Some patients develop gastroesophageal reflux disease (GERD) after a distal gastrectomy. In these patients, the evaluation of GERD with 24-h pH monitoring could be difficult because they may have an insufficient amount of gastric acid.
  
  
  METHODS
  To evaluate GERD following a distal gastrectomy, we retrospectively evaluated 38 patients postoperatively with an acid reflux test (ART), a barium study, endoscopy, and esophageal manometry. Three reconstructive procedures, Billroth I (B-I group: 14 patients), Billroth II (B-II group: 11 patients), and jejunal interposition (interposition group: 13 patients) were compared with respect to GERD and short- term operation results.
  
  
  RESULTS
  Operation time and postoperative hospital stay were longest in the interposition group. Reflux symptoms were present in ten patients (26%). The ART, barium study and endoscopy demonstrated evidence of GERD in 22 (58%), 10 (26%) and 4 (11%) of the 38 patients, respectively. The frequency of a positive ART in the interposition group was significantly lower than in both the B-I and the B-II groups. The abdominal length of the lower esophageal sphincter in the interposition group was higher than that in the B-II group ( P<0.05).
  
  
  CONCLUSIONS
  Although jejunal interposition required longer operation time and hospital stay, the lower esophageal sphincter function following jejunal interposition appears to be superior to that following a Billroth-I or Billroth-II procedure.
authors.affiliation: Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, 466-8550 Nagoya, Japan.
authors.forename: Takeo
authors.initials: T
authors.lastname: Kawamura
authors.forename: Akihiro
authors.initials: A
authors.lastname: Yasui
authors.forename: Yoshihisa
authors.initials: Y
authors.lastname: Shibata
authors.forename: Norihiro
authors.initials: N
authors.lastname: Yuasa
authors.forename: Yuji
authors.initials: Y
authors.lastname: Nimura
mesh_terms: D000368:Aged; D004945:Esophagoscopy; D005260:Female; D005743:Gastrectomy / Q000379:methods*; D005764:Gastroesophageal Reflux / Q000175:diagnosis / Q000209:etiology*; D006801:Humans; D007902:Length of Stay; D008297:Male; D008365:Manometry; D008875:Middle Aged