Proton pump inhibitors relieve and prevent symptoms related to gastric acidity after esophagectomy.
BACKGROUND
Denervated stomach used as an esophageal substitute after esophagectomy often retains or spontaneously recovers acid production. The aims of the present study were to assess the relationship between esophageal acid exposure or gastric acidity and reflux-related symptoms after esophagectomy, and to assess the ability of proton pump inhibitors (PPIs) to relieve gastroesophageal reflux-related symptoms.


METHODS
Forty-four patients underwent esophageal and gastric 24-h pH monitoring early after esophagectomy with gastric reconstruction. Initially, patients with both gastric acidity and reflux symptoms were treated with PPIs (Treatment group), then all patients with gastric acidity, whether symptomatic or not, were treated (Prevention group). Reflux-related symptoms were correlated with esophageal acid exposure and postoperative gastric acidity. Gastric acidity was then correlated with serum anti-Helicobacter pylori immunoglobulin G (IgG) titers and preoperative endoscopic findings


RESULTS
Sixteen patients (36.4%) reporting reflux and showing gastric acid production were treated with PPIs, which provided relief to 13 (81.3%). Although symptoms did not correlate with the esophageal acid exposure, postoperative gastric acidity was significantly greater among patients who were symptomatic than among those who were not. Overall, acid production was lower in older patients (>64 years of age), although older patients who were H. pylori-negative and without chronic atrophic gastritis also showed high levels of gastric acidity.


CONCLUSIONS
Proton pump inhibitors should be administered prophylactically early after esophagectomy to relieve and prevent reflux-related symptoms. Candidates for preventive therapy include those less than 64 years of age or older patients who are H. pylori-negative and without chronic atrophic gastritis.
Okuyama
Manabu
M
Department of Surgery, Akita University School of Medicine, Hondo, Akita City, 010-8543, Japan. okumana67@yahoo.co.jp
Motoyama
Satoru
S
Maruyama
Kiyotomi
K
Sasaki
Kenji
K
Sato
Yusuke
Y
Ogawa
Jun-ichi
J
D053799:2-Pyridinylmethylsulfinylbenzimidazoles / Q000627:therapeutic use*; D000368:Aged; D015331:Cohort Studies; D004940:Esophageal Stenosis / Q000150:complications; D016629:Esophagectomy / Q000009:adverse effects*; D004944:Esophagoplasty / Q000009:adverse effects; D005260:Female; D005744:Gastric Acid / Q000378:metabolism*; D005745:Gastric Acidity Determination; D005753:Gastric Mucosa / Q000637:transplantation; D005764:Gastroesophageal Reflux / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D054328:Proton Pump Inhibitors / Q000627:therapeutic use*; D064750:Rabeprazole; D012307:Risk Factors; D016896:Treatment Outcome
D053799:2-Pyridinylmethylsulfinylbenzimidazoles; D054328:Proton Pump Inhibitors; D064750:Rabeprazole