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Gastroesophageal Reflux After Gastric Surgery

  • Mamoru Hiraishi
  • Toshiro Konishi
  • Kiyoshi Mori
  • Ken-ichi Mafune
  • Takeshi Miyama
  • Tooru Hirata
  • Haruhiro Nishina
  • Yasuo Idezuki
Conference paper

Summary

Esophageal and gastric pH monitoring and endoscopic examination of the esophagus were performed in patients after gastric surgery. The duration time and frequency of gastroesophageal reflux were studied using an ambulatory 24-h pH monitoring system. The subjects consisted of 43 patients with distal gastrectomy, 3 patients with proximal gastrectomy, 19 patients with total gastrectomy, 9 patients with reflux esophagitis without previous gastric surgery, and 53 preoperative patients. Esophageal and gastric pH were measured 5 cm above and 5 cm or 10 cm below the esophagogastric junction (EGJ). The duration, ratio and frequency of acid (pH <4.0) and alkaline (pH >7.4) reflux, acid and alkaline clearance time, and mean and median pH were measured. From the pattern of the esophageal pH curve, patients were divided into four groups: normal, acid reflux, alkaline reflux, and mixed type. In patients who received distal gastrectomy, acid reflux time (pH < 4) was longer than in preoperative patients. The most common reflux patterns were acid reflux and alkaline reflux. There were some tendencies to reflux when in the supine position, and before and after meals. Endoscopic findings of the esophagus were almost normal, but after iodine staining, slightly unstained patchy areas were recognized in patients in these two groups. After total gastrectomy, alkaline reflux time (pH >7.4) and alkaline clearance time were longer than in preoperative patients. There were a few patients who showed small changes in esophageal pH in spite of esophagitis; the esophagitis in these patients was considered to be due to pancreatic enzymes.

Keywords

Gastroesophageal Reflux Total Gastrectomy Reflux Esophagitis Distal Gastrectomy Acid Reflux 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

  1. 1.
    Johnson LF, DeMeester TR (1974) Twenty-four-hour pH monitoring of the distal esophagus: A quantitative measure of gastroesophageal reflux. Am J Gastroenterol 62: 325–332PubMedGoogle Scholar
  2. 2.
    DeMeester TR, Johnson LF, Joseph GJ, Toscano MS, Hall AW, Skinner DB (1976) Patterns of gastroesophageal reflux in health and disease. Ann Surg 184: 459–470PubMedCrossRefGoogle Scholar
  3. 3.
    Cortesini C, Marcuzzo G, Pucciani F (1985) Relationship between mixed acid-alkaline gastroesophageal reflux and esophagitis. It J Surg Sci 15i: 9–15Google Scholar
  4. 4.
    Penagini R, Yuen H, Misiewict JJ, Bianchi PA (1988) Alkaline intraesophageal pH and gastrooesophageal reflux in patients with peptic oesophagitis. Scand J Gastroenterol 23: 675–678PubMedCrossRefGoogle Scholar
  5. 5.
    Stoker DL, Williams JG (1991) Alkaline reflux esophagitis. Gut 32: 1090–1092PubMedCrossRefGoogle Scholar
  6. 6.
    Gotley DC, Ball DE, Owen RW, Williamson RCN, Cooper MJ (1992) Evaluation and surgical correction of esophagitis after partial gastrectomy. Surg 111: 29–36Google Scholar

Copyright information

© Springer-Verlag Tokyo 1993

Authors and Affiliations

  • Mamoru Hiraishi
  • Toshiro Konishi
  • Kiyoshi Mori
  • Ken-ichi Mafune
  • Takeshi Miyama
  • Tooru Hirata
  • Haruhiro Nishina
  • Yasuo Idezuki
    • 1
  1. 1.Second Department of SurgeryUniversity of TokyoBunkyo-ku, Tokyo, 113Japan

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