CONTRIBUTION OF ACID AND DUODENOGASTRO-ESOPHAGEAL REFLUX TO ESOPHAGEAL MUCOSAL INJURY AND SYMPTOMS IN PARTIAL GASTRECTOMY PATIENTS

Background-The role of acid and pepsin in causing symptoms and oesopha gitis is well established; however, the significance of duodenogastro- oesophageal reflux (DGOR) in this disorder is unclear. Aims-To underst and the role of acid and DGOR in causing upper gastrointestinal (GI) s ymptoms and oesophageal mucosal injury in partial gastrectomy (PG) pat ients. Methods-Thirty two PG patients with upper GI symptoms were stud ied. Twenty four hour ambulatory acid and bilirubin measurements were obtained with Bilitec 2000 using glass electrode and fibreoptic sensor . Upper GI symptoms and oesophagitis were correlated with either acid or DGOR. Results-The PG patients were a heterogeneous group: 28% (9/32 ) had mixed reflux (acid+/DGOR+); 50% (16/32) had only DGOR (acid-/DGO R+); and 22% (7/32) had neither (acid-/DGOR-). Upper GI symptoms were associated with both mixed reflux (69%) and DGOR (24%). Six patients ( 67%) in the acid+/DGOR+ group had oesophagitis; no acid-/DGOR+ or acid -/DGOR- patients had oesophagitis. Mixed reflux showed a significant ( p<0.0001) association with oesophagitis, while DGOR did not (p=0.3). C onclusions-(1) The majority of upper GI symptoms and all cases of oeso phagitis in the PG patients occurred in patients who had mixed refluxa te (acid and DGOR); (2) DGOR without simultaneous acid reflux may caus e symptoms, but was not associated with oesophagitis in this patient g roup.