CHARACTERISTICS OF DISTAL PARTIAL GASTRECTOMY PATIENTS WITH ESOPHAGEAL SYMPTOMS OF DUODENOGASTRIC REFLUX

Objectives: Partial gastrectomy patients with anatomic alterations to the pylorus and acid secretion are excellent models for studying the c ontroversial role of duodenogastric reflux in producing esophageal sym ptoms and esophagitis. Methods: We studied 13 partial gastrectomy pati ents who had recent upper gastrointestinal endoscopies and chronic duo denogastric reflux symptoms. Simultaneously, acid and duodenogastric r eflux were assessed by ambulatory 24-h esophageal pH and bilirubin mon itoring. Abnormal values for both acid and bilirubin reflux were defin ed by previous studies of healthy volunteers from our laboratory. Symp toms were recorded and correlated with acid and duodenogastric reflux episodes. Results: Mean percent time bilirubin reflux for the entire g roup was 26.8 +/- 7.2% (range 0.4-91.2%), whereas mean percent total a cid reflux was 4.6 +/- 2.4% (range 0.0-26.1%). Ten (77%) patients had abnormal duodenogastric reflux, but three patients (23%) also had asso ciated abnormal acid reflux. Only these three patients had esophagitis , two ulcerative and one Barrett's esophagus. A total of 75 symptoms ( 36 heartburn, 33 epigastric pains, three regurgitation, two nausea/vom iting, one abdominal distension) were reported; 65% were acid related. Of patients with heartburn and regurgitation, 97% were associated wit h acid reflux episodes. Conclusions: Although excessive amounts of duo denogastric reflux are common in partial gastrectomy patients, esophag itis and Barrett's esophagus are seen only in patients with concomitan t acid reflux, and most esophageal symptoms are acid related. Therefor e, acid rather than duodenogastric reflux is the main culprit in this syndrome and should be aggressively treated.