title: Should peri-gastrectomy gastric acidity be our focus among gastric cancer patients?
abstract: OBJECTIVE
  To investigate the necessity and correctness of acid suppression pre- and post-gastrectomy among gastric carcinoma (GC) patients.
  
  
  METHODS
  From June 2011 to April 2013, 99 patients who were diagnosed with GC or adenocarcinoma of the gastroesophageal junction (type II or III) and needed surgical management were enrolled. They all underwent gastrectomy by the same operators [35 undergoing total gastrectomy (TG) plus Roux-en-Y reconstruction, 34 distal gastrectomy (DG) plus Billroth I reconstruction, and 30 proximal gastrectomy (PG) plus gastroesophagostomy]. We collected and analyzed their gastrointestinal juice and tissues from the pre-operational day to the 5(th) day post-operation, and 6 mo post-surgery. Gastric pH was detected with a precise acidity meter. Gastric juice contents including potassium, sodium and bicarbonate ions, urea nitrogen, direct and indirect bilirubin, and bile acid were detected using Automatic Biochemical Analyzer. Data regarding tumor size, histological type, tumor penetration and tumor-node-metastasis (TNM) stage were obtained from the pathological records. Reflux symptoms pre- and 6 mo post-gastrectomy were evaluated by reflux disease questionnaire (RDQ) and gastroesophageal reflux disease questionnaire (GERD-Q). SPSS 16.0 was applied to analyze the data.
  
  
  RESULTS
  Before surgery, gastric pH was higher than the threshold of hypoacidity (4.25 ± 1.45 vs 3.5, P = 0.000), and significantly affected by age, tumor size and differentiation grade, and potassium and bicarbonate ions; advanced malignancies were accompanied with higher pH compared with early ones (4.49 ± 1.31 vs 3.66 ± 1.61, P = 0.008). After operation, gastric pH in all groups was of weak-acidity and significantly higher than that pre-gastrectomy; on days 3-5, comparisons of gastric pH were similar between the 3 groups. Six months later, gastric pH was comparable to that on days 3-5; older patients were accompanied with higher total bilirubin level, indicating more serious reflux (r = 0.238, P = 0.018); the TG and PG groups had higher RDQ (TG vs DG: 15.80 ± 5.06 vs 12.26 ± 2.14, P = 0.000; PG vs DG: 15.37 ± 3.49 vs 12.26 ± 2.14, P = 0.000) and GERD-Q scores (TG vs DG: 10.54 ± 3.16 vs 9.15 ± 2.27, P = 0.039; PG vs DG: 11.00 ± 2.07 vs 9.15 ± 2.27, P = 0.001) compared with the DG group; all gastric juice contents except potassium ion significantly rose; reflux symptom was significantly associated with patient's body mass index, direct and indirect bilirubin, and total bile acid, while pH played no role.
  
  
  CONCLUSIONS
  Acidity is not an important factor causing unfitness among GC patients. There is no need to further alkalify gastrointestinal juice both pre- and post-gastrectomy.
authors.affiliation: Lei Huang, A-Man Xu, Wen-Xiu Han, Jing Xu, Department of General Surgery, the First Affiliated Hospital of Anhui Medical University, Hefei 230022, Anhui Province, China.
authors.forename: Lei
authors.initials: L
authors.lastname: Huang
authors.affiliation: Lei Huang, A-Man Xu, Wen-Xiu Han, Jing Xu, Department of General Surgery, the First Affiliated Hospital of Anhui Medical University, Hefei 230022, Anhui Province, China.
authors.forename: A-Man
authors.initials: AM
authors.lastname: Xu
authors.affiliation: Lei Huang, A-Man Xu, Wen-Xiu Han, Jing Xu, Department of General Surgery, the First Affiliated Hospital of Anhui Medical University, Hefei 230022, Anhui Province, China.
authors.forename: Tuan-Jie
authors.initials: TJ
authors.lastname: Li
authors.affiliation: Lei Huang, A-Man Xu, Wen-Xiu Han, Jing Xu, Department of General Surgery, the First Affiliated Hospital of Anhui Medical University, Hefei 230022, Anhui Province, China.
authors.forename: Wen-Xiu
authors.initials: WX
authors.lastname: Han
authors.affiliation: Lei Huang, A-Man Xu, Wen-Xiu Han, Jing Xu, Department of General Surgery, the First Affiliated Hospital of Anhui Medical University, Hefei 230022, Anhui Province, China.
authors.forename: Jing
authors.initials: J
authors.lastname: Xu
mesh_terms: D000230:Adenocarcinoma / Q000378:metabolism / Q000473:pathology / Q000601:surgery*; D000368:Aged; D000713:Anastomosis, Roux-en-Y / Q000009:adverse effects; D004943:Esophagogastric Junction / Q000378:metabolism / Q000473:pathology / Q000601:surgery*; D004946:Esophagostomy / Q000009:adverse effects; D005260:Female; D005743:Gastrectomy / Q000009:adverse effects*; D005744:Gastric Acid / Q000378:metabolism*; D005745:Gastric Acidity Determination; D005750:Gastric Juice / Q000378:metabolism*; D005763:Gastroenterostomy / Q000009:adverse effects; D005764:Gastroesophageal Reflux / Q000209:etiology* / Q000378:metabolism / Q000517:prevention & control; D005774:Gastrostomy / Q000009:adverse effects; D006801:Humans; D006863:Hydrogen-Ion Concentration; D008297:Male; D008875:Middle Aged; D019990:Perioperative Care; D012307:Risk Factors; D013274:Stomach Neoplasms / Q000378:metabolism / Q000473:pathology / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome
keywords: Acidity; Gastrectomy; Gastric carcinoma; Gastrointestinal juice; Reflux