Comparison of gastroesophageal reflux in 100 patients with or without prior gastroesophageal surgery.
OBJECTIVE
The role of duodenogastroesophageal reflux (DGER) in gastroesophageal reflux disease (GERD) remains controversial. Few studies of reflux have compared patients with an intact stomach to those without intact stomach after gastroesophageal surgery. This study aimed to investigate differences of the refluxate between patients with and without prior gastroesophageal surgery and to assess the role of DGER in GERD.


METHODS
One hundred patients (34% with reflux symptoms) were divided into four groups: 23 with an intact stomach, and 27, 42, and 8 with esophagectomy followed by gastric tube reconstruction, distal gastrectomy, and total gastrectomy, respectively. Reflux symptoms were evaluated, and endoscopy and simultaneous 24-h monitoring of esophageal pH and bilirubin were performed.


RESULTS
Of 44 patients with increased DGER but without increased acid reflux, three had severe reflux esophagitis and seven had Barrett's esophagus. DGER was most frequent under weakly acidic conditions in the intact stomach, esophagectomy, and distal gastrectomy groups. Pure acid reflux and DGER at any pH were elevated in GERD patients with an intact stomach, while weakly acidic and alkaline DGER were elevated in GERD patients after gastrectomy. Esophagectomy patients had reflux with the combined characteristics of those in the intact stomach and gastrectomy groups. Weakly acidic or alkaline DGER was correlated with symptoms and esophageal mucosal changes in gastrectomy patients.


CONCLUSIONS
The refluxate causing GERD differed between patients with and without prior gastroesophageal surgery. Weakly acidic or alkaline DGER may cause both symptoms and esophageal mucosal damage.
Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan. nyuasa@nagoya-1st.jrc.or.jp
Norihiro
N
Yuasa
Tetsuya
T
Abe
Eiji
E
Sasaki
Masahide
M
Fukaya
Yuji
Y
Nimura
Ryoji
R
Miyahara
D000328:Adult; D000368:Aged; D001663:Bilirubin / Q000032:analysis; D004383:Duodenogastric Reflux / Q000150:complications*; D016145:Endoscopy, Digestive System; D050782:Esophageal pH Monitoring; D016629:Esophagectomy / Q000009:adverse effects*; D004942:Esophagitis, Peptic / Q000175:diagnosis; D005260:Female; D005743:Gastrectomy / Q000009:adverse effects*; D005764:Gastroesophageal Reflux / Q000209:etiology*; D006801:Humans; D006863:Hydrogen-Ion Concentration; D008297:Male; D008875:Middle Aged
D001663:Bilirubin