Functional Disorder of Esophago-gastric Junction in Post-gastrectomy Patients

Katsuhiko Ishizaka, Harutsugu Sodeyama, Chiharu Takahashi, Takai Kuroda, Futoshi Iida

Department of Surgery, Shinshu University School of Medicine

Endoscopic and manometric studies were undertaken to determine the incidence of hiatus hernia and the functional changes in the cardia in post-gastrectomy patients. One hundred and four post-gastrectomy patients and 399 non-gastrectomy patients were subjected to endoscopic study for obsrving the cardia. Manometric study was also carried out on 56 patients with gastric carcinoma and 19 patiens with gall stones, by an intraluminal transducer technique. Loweresohageal sphincter pressures (LESP) were measured with a catheter-tip pressure transducer, by both the slow pull-through technique (SPT) and the rapid pull-through technique (RPT), before and 6 months after surgery. Hiatus hernia was observed in 37.5% of the post-gastrectomy patients, which was significantly higher than 19.3% of the non-gastrectomy patients (p<0.01). In the post-gastrectomy patients, reflux esophagitis was observed in 20.2%. There were no significant differences between the patients receiving Billroth 1 and Billroth 2 gastrectomy and bewteen the patients with and without a hernia. The manometric study revealed that LESP was not changed by cholecystectomy but was significantly decreased after distal gastrectomy. LESP measured by SPT were 10.8±4.3 mmHg before and 8.2±3.2 mmHg after distal gastrectomy (p<0.01), while those measured by SPT were 14.3±5.6 mmHg before and 12.2±5.4 mmHg after distal gasrectomy (p<0.05). The decrease rate in LESP in the patients receiving Billroth 2 gastrectomy were higher than those in the patients receiving Billroth 1 gastrectomy. LESP in the patients with regurgitation symptms after distal gastrectomy were significantly lower than those without regurgitation symptoms. LESP was significantly decreased after total gastrectomy but was not related to regurgitation symptoms.

Key words
hiatus hernia, lower esophageal sphincter pressure, post-gastrectomy patients

Reprint requests
Katsuhiko Ishizaka Second Department of Surgery, Shinshu University School of Medicine
3-1-1 Asahi, Matsumoto, 390 JAPAN

Accepted
June 13, 1990

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