24-HOUR MONITORING OF PH IN THE GASTRIC TUBE REPLACING THE RESECTED ESOPHAGUS

BACKGROUND: Peptic ulcers in the gastric tube replacing the resected e sophagus develop silently and cause serious problems. Zn this study, t he acidity of the gastric tube was examined by 24-hour pH monitoring t o determine if the acidity of the gastric tube was sufficient to cause peptic ulcers. STUDY DESIGN: The acidity of a gastric tube was evalua ted by 24-hour pH monitoring of both the fundus and the antrum in 55 p atients treated for carcinoma of the esophagus. The correlation betwee n the fasting serum gastrin concentration and the intraluminal acidity of the completely vagotomized gastric tube was examined. RESULTS: in the patients with high postoperative acidity in the fundus or the antr um (46 percent of the 41 patients examined), the intraluminal pH remai ned consistently low, even long after operative treatment. Significant correlations existed between the percentage of time that the pH remai ned below 3 preoperatively and postoperatively in both the fundus and the antrum (r=0.4777, p=0.0386, and r=0.7597, p=0.0002, respectively). The percentage did not decrease significantly postoperatively. A sign ificantly negative correlation (r=-0.783401, p<0.0001) was found betwe en the fasting serum gastrin level and the proportion of time that the nocturnal pH in the antrum remained below 3. CONCLUSIONS: Even long a fter esophagectomy, the pH of the gastric tube is low enough to cause peptic ulcers, especially in patients with high preoperative acidity. in these patients, the intraluminal pH in the antrum of the gastric tu be correlates inversely with the fasting serum gastrin level.