Combined 24-hour intraluminal pH and bile monitoring of the denervated whole stomach as an esophageal substitute

BACKGROUND/AIMS: The study aims to evaluate the pH and the presence of bile in the denervated whole stomach pulled up to the neck after subtotal esoph agectomy METHODOLOGY: The pH and the presence of bile in the gastric cavity were mon itored by combined 24-hour pH and bilimetry in 16 patients having their who le stomach as an esophageal substitute (i.e., 8 with and 8 without a gastri c drainage procedure) and in 25 healthy control subjects. The percentage of time during which pH was <2 as well as the percentage of time during which bile absorbance was >0.25 for the total, upright, and supine periods of re cording were considered for each subject studied. Seven patients underwent a gastroscopy with biopsies. RESULTS: Intragastric acidity was normal in 50% of patients while it was re duced in the other 50%. Ten of the 16 patients (62.5%), i.e., 4 with (50%) and 6 without (75%) a drainage procedure, had excessive exposure of the gas tric mucosa to bile. No significant correlation was found between the exist ence of a high intraluminal pH profile and excessive bile exposure (p=0.916 3). Bile exposure was significantly higher in whole stomach patients than i n controls in both the upright and supine positions, irrespective of the ex istence or absence of a drainage procedure (p ranging from 0.0272-0.0001). Bile exposure in the supine position tended to be longer in patients withou t than in those with a drainage procedure (p =0.0929). Helicobacter pylori- negative chemical gastritis was present in 3 of the 7 patients who underwen t a gastroscopy, all 3 having excessive bile exposure and no food retention in the transplant lumen. CONCLUSIONS: Gastric denervation and transposition up to the neck increased exposure of the gastric mucosa to bile, irrespective of the patient's posi tion and of the presence of a gastric drainage procedure. The absence of ga stric drainage procedure tends to ensure exposure to bile prolongeLow gastr ic acidity, if present, is due to a reduction in acid secretion rather than to a buffering effect from duodenal juice having refluxed. Gastritis is mo re likely to be related to excessive exposure of the gastric mucosa to bile than to food retention.