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27-04-2010 | Gastroenterology | Article

LoRS major determinant of esophageal reflux content after PG

Abstract

Free abstract

MedWire News: Length of remaining stomach (LoRS) is a predictor of esophageal reflux content after proximal gastrectomy (PG), report researchers.

Upper third gastric cancer is often treated by total gastrectomy (TG) with D2 lymph node dissection but, as early detection of the condition has improved, more surgeons are choosing PG over TG for the treatment of these patients.

A problematic outcome of PG is common reflux symptoms. In this study, Han-Kwang Yang (Seoul National University College of Medicine, South Korea) and colleagues investigated the character of esophageal reflux in 24 patients, aged 58.9 years on average, who underwent PG for upper third gastric cancer between July 2008 and March 2009.

The team used wireless ambulatory 24-hr pH monitoring (Bravo pH monitoring system [Medtronic, Shoreview, Minnesota, USA]) to measure acid reflux (AR) and diisopropyl iminodiacetic acid hepatobiliary scanning (DISIDA) to measure bile reflux (BR) in the participants.

All the patients had reflux symptoms. Of these, 11 had only BR, seven only AR, two had AR and BR, and three had neither. After PG, reflux symptoms were related to either bile or acid rather than both, whereas before they were associated with either or both.

As reported in the Journal of Surgical Oncology, Yang et al observed that LoRS along the greater curvature was significantly shorter in patients with only BR than those with AR alone, at 16.11 versus 23.69 cm on average.

Of note, the severity of symptoms or esophagitis was not significantly associated with acid content or BR.

“We propose pH monitoring-based prescription of empirical drugs for the treatment of reflux symptoms in proximal gastrectomized patients,” say the authors.

“Furthermore,” they conclude, “the Bravo pH monitoring system was found to be useful for evaluating AR, whereas DISIDA was found to be useful for evaluating BR.”

They add: “We consider that both tests should be used to guide appropriate medication in cases with reflux symptoms after PG.”

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By Helen Albert