Must duodenal diversion be reserved for alkaline reflux?
In answering this question, it is important to note that two populations may be opposed in our series: those of esophagitis after UPG (Uppen Polar Gastrectomy) (8 cases), where the result of duodenal diversion is regularly good and long-lasting, and those of esophagitis after recurrence of hiatus hernia (5 cases) or after Heller’s operation (3 cases), which include the 2 poor results. This contrast is probably linked to the nature of the reflux. In UPG the reflux is alkaline, since there has been a TV (Truneal Vagotony) and an extensive gastric resection; the esophagitis is then early and severe. In recurrences after hiatus hernia or Heller operations the reflux is acid and the esophagitis develops later. But when there is no anatomic explanation to arouse suspicion of alkaline reflux, its diagnosis may encounter technical difficulties. In fact, endoscopy and scintigraphy with technetium-99 can diagnose duodenogastric reflux  but pH measurement cannot prove alkaline esophageal reflux since the esophageal pH is normally elevated and the recording is disturbed by the alkaline saliva .
KeywordsGastritis Esophagitis Motilin
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