LOWER ESOPHAGEAL SPHINCTER PRESSURE AFTER SUBTOTAL GASTRECTOMY AND POSTOPERATIVE REFLUX ESOPHAGITIS

Although reflux esophagitis after subtotal gastrectomy has been notice d by surgeons, the mecha nism of its development is obscure. This stud y was undertaken with the aim of clarifying the role of the lower esop hageal sphincter in the development of this abnormality. Manometric st udies were carried out on 42 patients with gastric cancer, and on 19 w ith cholelithiasis. The lower esophageal sphincter pressure was measur ed using a catheter tip pressure transducer and a rapid pull-through t echnique, and the results presented as the mean of three measurements. The technical error of this experiment was estimated to be within 2 m mNg by a study of the cholecystectomy patients. After gastrectomy, the lower esophageal pressure decreased in 17 patients, increased in 4 an d remained unchanged in 21. A more pronounced decrease in the lower es ophageal sphincter pressure was found after Billroth II. Clinical eval uation of the 42 patients revealed symptoms of postgastrectomy regurgi tation in 10. Preoperatively, these 10 had lower values of the lower e sophageal sphincter pressure followed by a more marked postoperative d ecrease, as compared with the patients with no regurgitation symptoms. Oral administration of a test meal revealed regurgitation after subto tal gastrectomy. This study suggests that a low value of the pre-opera tive lower esophageal sphincter pressure, a marked decrease in the pre ssure after gastrectomy, and Billroth II anastomosis, may be factors t hat predispose to regurgitation.