title: Gastric motor activity in gastric pull-up esophagectomized patients with and without reflux symptoms.
abstract: BACKGROUND
  Patients frequently experience reflux symptoms of heartburn and regurgitation after a gastric pull-up esophagectomy. The pathogenesis of reflux symptoms is not fully understood. The gastrointestinal tract exhibits a temporally coordinated cyclic motor pattern, termed interdigestive migrating motor contraction, during the interdigestive state. Phase III of interdigestive migrating motor contraction is important in cleaning indigestible solids and basal secretions. Impairment of phase III may result in reflux symptoms of heartburn and regurgitation. The present study evaluated whether gastropyloroduodenal motility after gastric pull-up esophagectomy influences the pathogenesis of reflux symptoms.
  
  
  METHODS
  Gastropyloroduodenal motility was recorded by manometry in 20 patients after a gastric pull-up esophagectomy. Esophagectomized patients were questioned about the presence of heartburn or regurgitation, or both.
  
  
  RESULTS
  Of 20 patients, 8 (40%) were considered the symptomatic group. Phase III, in which contractions originating from the antrum migrate to the pylorus and then move to the duodenum, was observed in only 1 of 8 patients. In the asymptomatic group, phase III was observed in 8 of 12 patients. A significant correlation was found between the presence of reflux symptoms and the paucity of phase III activity (p=0.02).
  
  
  CONCLUSIONS
  The presence of reflux symptoms after gastric pull-up esophagectomy is significantly associated with the paucity of gastric phase III. Gastric motor activity is important in the occurrence of reflux symptoms.
authors.affiliation: Department of Surgery, Gunma Prefectural Cardiovascular Center, Gunma University, Graduate School of Medicine, Maebashi, Japan. tnakaba@showa.gunma-u.ac.jp
authors.forename: Toshihiro
authors.initials: T
authors.lastname: Nakabayashi
authors.forename: Erito
authors.initials: E
authors.lastname: Mochiki
authors.forename: Yoichi
authors.initials: Y
authors.lastname: Kamiyama
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Kuwano
mesh_terms: D000368:Aged; D000714:Anastomosis, Surgical; D004386:Duodenum / Q000503:physiopathology* / Q000601:surgery; D004938:Esophageal Neoplasms / Q000150:complications / Q000601:surgery; D016629:Esophagectomy / Q000379:methods*; D004947:Esophagus / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D005746:Gastric Emptying / Q000502:physiology*; D005764:Gastroesophageal Reflux / Q000150:complications / Q000503:physiopathology* / Q000601:surgery; D006801:Humans; D008297:Male; D008365:Manometry; D008875:Middle Aged; D011312:Pressure; D013270:Stomach / Q000503:physiopathology / Q000601:surgery*; D016896:Treatment Outcome