title: Morphologic analysis of gastroesophageal reflux diseases in patients after distal gastrectomy.
abstract: The precise mechanisms that cause gastroesophageal reflux after distal gastrectomy remain unclear. We analyzed the endoscopic findings of the cardia and the position of the remnant stomach, which are related to gastroesophageal reflux. We retrospectively examined the records of 45 patients with Billroth I (B-I) and 39 patients with Roux-en-Y (R-Y) procedure for gastric cancer. Esophagitis was evaluated by the Los Angeles (LA) classification. The endoscopic findings of hiatus hernia were classified according to the criteria of the Keio Cancer Detection Center form (K-form). The valvular appearance of the cardia was classified according to V-grades. The height of the remnant stomach was measured on computed tomography scans. The postoperative findings of esophagitis in the B-I group were significantly worse than the preoperative findings, but no significant change was observed in the R-Y group. The postoperative V-grades and K-forrn findings in the B-I group were worse than their preoperative findings. In the R-Y group, however, there was no significant change in the V-grades or K-form findings. In addition, the height of the remnant stomach was significantly higher in the B-I group than in the R-Y group. This study suggested that an aggravated cardia is associated with the B-I procedure and that the position of the remnant stomach may therefore play an important role in the occurrence of postoperative reflux esophagitis. In contrast, the R-Y operation was shown to preserve the cardia and the position of the remnant stomach better. As a result, R-Y might help prevent not only duodenogastric reflux but also gastroesophageal reflux.
authors.affiliation: Department of Surgery, Keio University School of Medicine, 35 Shinanomachi, 160-8582 Shinjuku-ku, Tokyo, Japan.
authors.forename: Tsunehiro
authors.initials: T
authors.lastname: Takahashi
authors.forename: Masashi
authors.initials: M
authors.lastname: Yoshida
authors.forename: Tetsuro
authors.initials: T
authors.lastname: Kubota
authors.forename: Yoshihide
authors.initials: Y
authors.lastname: Otani
authors.forename: Yoshiro
authors.initials: Y
authors.lastname: Saikawa
authors.forename: Hideki
authors.initials: H
authors.lastname: Ishikawa
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Suganuma
authors.forename: Yukako
authors.initials: Y
authors.lastname: Akatsu
authors.forename: Koichiro
authors.initials: K
authors.lastname: Kumai
authors.forename: Masaki
authors.initials: M
authors.lastname: Kitajima
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000713:Anastomosis, Roux-en-Y; D002299:Cardia / Q000473:pathology; D016099:Endoscopy, Gastrointestinal; D004942:Esophagitis, Peptic / Q000473:pathology; D005260:Female; D005743:Gastrectomy / Q000379:methods; D018530:Gastric Stump / Q000473:pathology; D005763:Gastroenterostomy; D005764:Gastroesophageal Reflux / Q000473:pathology* / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000473:pathology*; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000601:surgery