title: Postprandial proximal gastric acid pocket in patients after distal gastrectomy.
abstract: BACKGROUND
  An unbuffered postprandial proximal gastric acid pocket (PPGAP) has been noticed in the majority of normal individuals and patients with gastroesophageal reflux disease. The role of gastric anatomy, specifically the antrum, in the physiology of the PPGAP is not yet fully elucidated. This study aims to analyze the presence of PPGAP in patients submitted to distal gastrectomy.
  
  
  METHODS
  A total of 15 patients who had a distal gastrectomy plus DII lymphadenectomy and Roux-en-Y reconstruction for gastric adenocarcinoma (mean age 64.3±8.4 years, 12 females) were studied. All patients were free of foregut symptoms after the operation. Patients underwent a high-resolution manometry. A station pull-through pH monitoring was performed from 5cm below the lower border of the lower esophageal sphincter (LBLES) to the LBLES in increments of 1cm in a fasting state and 10min after a standardized fatty meal. Postprandial proximal gastric acid pocket was defined by the presence of acid reading (pH<4) in a segment of the proximal stomach between non-acid segments distally (food) and proximally (LBLES). The PPGAP extent was recorded. The protocol was approved by local ethics committee. Key Results  Acidity was not detected in the stomach of nine patients before meal. After meal, PPGAP was not found in three patients. In three patients (20%), a PPGAP was noted with an extension of 1, 1 and 3cm.
  
  
  CONCLUSIONS
  In conclusion, PPGAP is present in a minority of patients after distal gastrectomy; this finding may suggest that the gastric antrum may play a role in the genesis of the PPGAP.
authors.affiliation: Department of Surgery, Escola Paulista de Medicina, Federal University of Sao Paulo, Sao Paulo, Brazil. herbella.dcir@epm.br
authors.forename: F A M
authors.initials: FA
authors.lastname: Herbella
authors.forename: F P P
authors.initials: FP
authors.lastname: Vicentine
authors.forename: L C
authors.initials: LC
authors.lastname: Silva
authors.forename: M G
authors.initials: MG
authors.lastname: Patti
mesh_terms: D000368:Aged; D005260:Female; D005743:Gastrectomy / Q000009:adverse effects*; D005744:Gastric Acid / Q000378:metabolism*; D006801:Humans; D008365:Manometry / Q000379:methods; D008875:Middle Aged; D019518:Postprandial Period / Q000502:physiology*; D011706:Pyloric Antrum / Q000033:anatomy & histology* / Q000601:surgery*; D013274:Stomach Neoplasms / Q000601:surgery