Analysis of esophageal reflux after proximal gastrectomy measured by wireless ambulatory 24-hr esophageal pH monitoring and TC-99m diisopropyliminodiacetic acid (DISIDA) scan.
OBJECTIVE
Reflux is one of the most common sequela after proximal gastrectomy (PG). The aim of this study was to find a predicting factor related to the character of esophageal reflux after PG.


METHODS
Wireless ambulatory 24-hr pH monitoring (for acid reflux, AR) and diisopropyliminodiacetic acid hepatobiliary scan (for bile reflux, BR) were performed on 24 patients who had reflux symptoms after PG with esophagogastrostomy from July 2008 to March 2009. Endoscopic examination was done and the length of remnant stomach (LoRS) was measure by postoperative UGI series.


RESULTS
Eleven patients (45.8%) had only BR, 7 (29.2%) had AR only, Two patients (8.3%) had both acid and BR, and 3 (12.5%) had neither. The LoRS along greater curvature was significantly shorter in patients with only BR (16.11 +/- 2.87 cm) than in patients with only AR (23.69 +/- 6.15 cm, P = 0.003). Severity of symptoms or esophagitis was not significantly correlated with the content of acid or BR.


CONCLUSIONS
Reflux symptom after PG is caused by either bile or acid rather than both. Character of reflux was related to the LoRS.
Kim
Jong Won
JW
Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea.
Yoon
Hongman
H
Kong
Seong-Ho
SH
Kim
Joo-Sung
JS
Paeng
Jin Chul
JC
Lee
Hyuk-Joon
HJ
Lee
Kuhn Uk
KU
Yang
Han-Kwang
HK
D001655:Bile Reflux / Q000000981:diagnostic imaging*; D050782:Esophageal pH Monitoring / Q000009:adverse effects / Q000295:instrumentation; D004945:Esophagoscopy; D005260:Female; D005744:Gastric Acid / Q000378:metabolism*; D005764:Gastroesophageal Reflux / Q000175:diagnosis*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011178:Postgastrectomy Syndromes / Q000175:diagnosis* / Q000000981:diagnostic imaging; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D012720:Severity of Illness Index; D019785:Technetium Tc 99m Disofenin
D019275:Radiopharmaceuticals; D019785:Technetium Tc 99m Disofenin