title: Significance of the lower esophageal sphincter preservation in preventing alkaline reflux esophagitis in patients after total gastrectomy reconstructed by Roux-en-Y for gastric cancer.
abstract: To clarify the significance of the lower esophageal sphincter (LES) for prevention of alkaline reflux esophagitis (ARE) after total gastrectomy reconstructed by Roux-en-Y (TGRY) for gastric cancer, we investigated LES function and lower esophageal pH in TGRY patients with or without LES preservation. A total of 51 patients 5 years after TGRY were divided into groups A (26 patients without preserved LES) and B (25 patients with preserved LES) and compared with 22 control participants (group C). Manometric study and ambulatory 24-hour esophageal pH monitoring were performed on all patients. Symptomatic and endoscopic AREs in group A were significantly higher than those in group B (P < 0.05). The length of LES and maximum LES pressure in group A were significantly shorter and lower, respectively, than in groups B and C (P < 0.01). The length of LES and maximum LES pressure in patients with symptomatic ARE were significantly shorter and lower, respectively, than in patients without symptomatic ARE (P < 0.01). Percentages of time with pH >7 and pH >8 within 24 hours in group A were significantly higher than those in groups B and C (P < 0.01). Preservation of the LES may be necessary to prevent ARE after TGRY.
authors.affiliation: 1 Department of Surgery, Nippon Dental University School of Life Dentistry at Tokyo, Tokyo, Japan.
authors.forename: Ryouichi
authors.initials: R
authors.lastname: Tomita
authors.forename: Kenichi
authors.initials: K
authors.lastname: Sakurai
authors.forename: Shigeru
authors.initials: S
authors.lastname: Fujisaki
mesh_terms: D000368:Aged; D000713:Anastomosis, Roux-en-Y; D049630:Esophageal Sphincter, Lower / Q000503:physiopathology / Q000601:surgery*; D050782:Esophageal pH Monitoring; D004942:Esophagitis, Peptic / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D005260:Female; D005743:Gastrectomy / Q000379:methods*; D005764:Gastroesophageal Reflux / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D006801:Humans; D008297:Male; D008365:Manometry; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D013274:Stomach Neoplasms / Q000601:surgery*