A Study on Gastroesophageal Reflux Disease (GERD) after Distal Gastrectomy

Yoshitetsu Kawa, Akiyoshi Seshimo and Shingo Kameoka

Tokyo Women's Medical University, Department of Surgery II

Background: We evaluated the condition of postoperative gastroesophageal reflux disease (GERD) after distal gastrectomy. Subjects and Method: We investigated the questionnaires about reflux for 109 patients who underwent distal gastrectomy for gastric cancer. On the basis this, we examined the pre-and postoperative His angle, the length of the residual stomach's lesser curvature, sex, lymphnodal dissection and connection with reflux symptoms. In 26cases, the severity of esophageal biliary reflux was determined with Bilitec2000 postoperatively. Based on these findings, the presence or absence of reflux esophagitis and above factors and severity of biliary reflux were examined. Results: A questionnaire showed reflux symptoms (reflux group) in 23 (21%). Among etiological factors positive for reflux, postoperative His angles were 92.6±32.2° in the reflux group and 74.7±26.5° in the non-reflux group. In the reflux group, the angle increased (p=0.007). We studied the length of the residual stomach's lesser curvature (N cm). Reflux was observed in 9 (41%) of 22 patients with an N of 5 or less, (p=0.026). The incidences of reflux in men was 15.5% and women 31.6%. We measured the frequency of bile regurgitation in 26 patients using a Bilitec 2000 (Synectics Medical AB, Stockholm, Sweden) device. In 20 patients in whom the frequency of bile regurgitation was 5% or more, the His angle was 90.6±21.5°. In 6 with regurgitation of less than 5%, the His angle was 74.5±14.2°. In the group with bile regurgitation, the His angle increased. Conculusions: Based on these results, we concluded that morphological changes in the cardia, demonstrated by enlargement of the His angle, residual stomach size, and gender are important in determining the onset of GERD after distal gastrectomy.

Key words
gastric cancer, distal gastrectomy, gastroesophageal reflux disease (GERD), esophageal biliary reflux

Reprint requests
Yoshitetsu Kawa Department of Surgery, Omiya Chuo General Hospital 1-227 Higashioonari-machi, Saitama, 330-0037 JAPAN

Accepted
January 22, 2003

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