Esophageal manometric changes and gastroesophageal reflux symptoms after distal gastrectomy for gastric cancer.
OBJECTIVE
Gastroesophageal reflux is known to be a common complication after gastrectomy. However, its mechanism is not completely understood. We investigated the effects of distal gastrectomy for gastric cancer on the lower esophageal sphincter (LES) and esophageal motility.


METHODS
In 18 patients who underwent distal gastrectomy reconstructed with Billroth I method for gastric cancer, esophageal motility and LES function were evaluated by means of a low-compliance manometric system. The LES pressure was determined by a rapid pull-through technique. Endoscopy before and after operation determined presence or absence of esophagitis and hiatus hernia.


RESULTS
No significant differences were observed in esophageal contractile amplitudes before and after distal gastrectomy. After distal gastrectomy, five patients had reflux symptoms of heartburn and regurgitation; 11 had none. Endoscopy revealed esophagitis after distal gastrectomy in two patients with reflux symptoms and one patient without reflux symptoms. The LES pressure in patients with reflux symptoms decreased significantly after distal gastrectomy (before gastrectomy: 26.1 +/- 1.1 mmHg, after distal gastrectomy: 15.3 +/- 3.5 mmHg, p<0.05). There was no significant change in patients without reflux symptoms.


CONCLUSIONS
This study demonstrated that LES pressure after distal gastrectomy in patients with reflux symptoms was significantly lower than that before gastrectomy. This result suggested that LES pressure decrease plays an important role in development of gastroesophageal reflux after distal gastrectomy reconstruction with the Billroth I method.
Haga
Norihiro
N
Department of Surgery, Gunma Cancer Center, Ota, Japan. hagan@gunma-cc.jp
Mochiki
Erito
E
Nakabayashi
Toshihiro
T
Suzuki
Tomoaki
T
Asao
Takayuki
T
Kuwano
Hiroyuki
H
D049630:Esophageal Sphincter, Lower / Q000503:physiopathology*; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy / Q000009:adverse effects*; D005764:Gastroesophageal Reflux / Q000209:etiology* / Q000503:physiopathology; D005769:Gastrointestinal Motility / Q000502:physiology*; D006321:Heart; D006801:Humans; D008197:Lymph Node Excision; D008297:Male; D008365:Manometry; D008875:Middle Aged; D013270:Stomach; D013274:Stomach Neoplasms / Q000503:physiopathology / Q000601:surgery*