Langenbecks Arch Surg (2003) 388:250–254 DOI 10.1007/s00423-003-0399-x
Takeo Kawamura Akihiro Yasui Yoshihisa Shibata Norihiro Yuasa Yuji Nimura
Received: 28 February 2003 Accepted: 3 June 2003 Published online: 9 August 2003 © Springer-Verlag 2003
T. Kawamura · A. Yasui · Y. Shibata N. Yuasa (✉) · Y. Nimura Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, 466-8550 Nagoya, Japan e-mail:
[email protected] Tel.: +81-52-7442220 Fax: +81-52-7442230
O R I G I N A L A RT I C L E
Evaluation of gastroesophageal reflux disease following various reconstructive procedures for a distal gastrectomy
Abstract Background and aims: Some patients develop gastroesophageal reflux disease (GERD) after a distal gastrectomy. In these patients, the evaluation of GERD with 24-h pH monitoring could be difficult because they may have an insufficient amount of gastric acid. Patients and methods To evaluate GERD following a distal gastrectomy, we retrospectively evaluated 38 patients postoperatively with an acid reflux test (ART), a barium study, endoscopy, and esophageal manometry. Three reconstructive procedures, Billroth I (B-I group: 14 patients), Billroth II (B-II group: 11 patients), and jejunal interposition (interposition group: 13 patients) were compared with respect to GERD and short- term operation results. Results: Operation time and postoperative hospital stay were longest in the interposition group. Reflux symptoms were present in ten patients
Introduction Gastroesophageal reflux disease (GERD) is a common complication following a distal gastrectomy. The combination of antrectomy and pylorectomy decreases gastrin secretion and allows unhindered retrograde flow of duodenal contents into the gastric remnant, which cannot accommodate the volume. GERD and reflux esophagitis may also be exacerbated by other conditions, including decreased lower esophageal sphincter pressure (LESP) [1], decreased lower esophageal sphincter (LES) length, abnormal clearance of refluxate from the distal esopha-
(26%). The ART, barium study and endoscopy demonstrated evidence of GERD in 22 (58%), 10 (26%) and 4 (11%) of the 38 patients, respectively. The frequency of a positive ART in the interposition group was significantly lower than in both the B-I and the B-II groups. The abdominal length of the lower esophageal sphincter in the interposition group was higher than that in the B-II group (P
