Gastric acidity following pancreaticogastrostomy with pylorus-preserving pancreaticoduodenectomy

Pancreaticogastrostomy (PG) has been reintroduced and employed occasionally as a useful alternative to pancreaticojejunostomy (PJ) after Whipple resec tion or pylorus-preserving pancreaticoduodenectomy (PPPD). Although the phy siologic alteration in the stomach is important for the correlation between gastric and pancreatic functions, the actual intragastric pH profile after PG is still unclear. This study was conducted to investigate the physiolog ic changes in gastric pH and serum gastrin and secretin levels before and a fter PPPD reconstructed with PG (PPPD-PG) in humans. Twenty-four hour conti nuous intragastric pH and serum gastrin and secretin levels in the fasting state were examined in 25 patients who had undergone PPPD-PG. No peptic ulc er was detected after the operation. After PG, serum gastrin and secretin l evels were unchanged. Twenty-four hour gastric pH monitoring revealed two d istinct patterns during the nocturnal period before the operation: patients with acid-type secretion (n = 11) exhibited a persistent acid pH, whereas those with alkaline-type secretion (n = 14) had cyclic variations between a n acid and an alkaline pH value. After PG, in both acid- and alkaline-type patients, median pH and percentages of time that the gastric pH was less th an 4 (clo pH < 4) and more than 6 (% pH > 6) did not change, and circadian pH patterns also remained unchanged. These results suggest that PPPD-PG has little influence on gastric acidity, and the neurohumoral relation between the stomach, duodenum, and pancreas is preserved after PG. Therefore, phys iologically, PG can be recommended as a reconstructive procedure after PPPD .