Reflux Esophagitis after Total Gastrectomy with Manometric Study and 24-hour pH Monitoring Influence in Lower Esophageal High Pressure Zone

Toyohide Nakamura, Kimio Namatame

Department of Surgery, Showa University Fujigaoka Hospital

To study the causal factors of refluex esophagitis after total gastrectomy, we performed an endoscopic observation and manonetric study of the lower esophageal high pressure zone (LEHPZ) in 59 postoperative patients. In 17 of the 59 patients, 24-hr pH monitoring measurement was conducted. The results were as follows. 1) Endoscopy revealed 11 cases of esophagitis (18.6%). The most frequent site of the esophagitis was around the oral side of anastomosis. 2) Among 3 reconstructive procedures, the ρ-Roux en-Y type was followed by esophagiits at the lowest incidence (8/50, 16%). 3) Under the definition that regurgitation to the esophagus was above pH 7.5 by 24-hr pH monitoring measurement, every factor of the reflux was higher in the esophagitis group than the free goup. 4) The High Pressure Zone (Tone) was significantly preserved in the group with a resected esophagus of 5 mm or less. 5) HPZ (T) correlated inversely with the total percent of time and number of reflux episodes. We conclude that the preservation of HPZ (T) depends on the length of the resected esophagus. Either a low or no HPZ (T), or any factor of regurgitation is a high risk factor of alkaline esophagitis. For such high risk patients, close endoscopic observation is mandatory.

Key words
reflux esophagitis after total gastrectomy, lower esophageal high pressure zone, alkaline reflux esophagitis, pH monitoring

Reprint requests
Toyohide Namamura Department of Surgery, Showa University Fujigaoka Hospital
1-30 Fujigaoka Midoriku Yokohama, Kanagawa, 227 JAPAN

Accepted
February 10, 1993

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