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Evaluation and surgical correction of esophagitis after partial gastrectomy
D C Gotley1, D E Ball, R W Owen
1University Department of Surgery, Bristol Royal Infirmary, U.K.
Surgery
|January 1, 1992
Summary
Refractory reflux esophagitis after gastrectomy is linked to nocturnal trypsin and bile acid exposure. Roux-en-Y conversion effectively resolves esophagitis symptoms, improving patient outcomes.
Area of Science:
- Gastroenterology
- Surgical Gastroenterology
- Esophageal Diseases
Background:
- Refractory symptomatic reflux esophagitis can occur in patients with a history of partial gastrectomy.
- Previous peptic ulcer surgery, including Billroth I or II resections, may predispose patients to complex esophageal issues.
- Identifying the specific etiological factors in post-gastrectomy esophagitis is crucial for effective treatment.
Purpose of the Study:
- To investigate the potential causes of refractory reflux esophagitis in patients with prior partial gastrectomy.
- To evaluate the efficacy of Roux-en-Y gastroenterostomy conversion in managing severe post-gastrectomy esophagitis.
- To analyze the composition of esophageal aspirates for specific digestive enzymes and bile acids.
Main Methods:
- Study included 8 patients with refractory reflux esophagitis post-partial gastrectomy.
- Pre- and post-conversion evaluations included symptom scoring, endoscopy, 24-hour pH monitoring, and esophageal aspiration analysis.
- Esophageal aspirates were analyzed for acid, pepsin, conjugated and unconjugated bile acids, and trypsin.
Main Results:
- Conjugated bile acids and trypsin were significantly elevated in esophageal aspirates of patients with severe esophagitis, particularly during nocturnal rest.
- Following Roux-en-Y conversion, esophagitis, heartburn, regurgitation, and bilious vomiting were eradicated in all patients.
- Other post-gastrectomy symptoms like early satiety, dumping, epigastric pain, and diarrhea remained largely unchanged.
Conclusions:
- Nocturnal exposure to trypsin and conjugated bile acids is a likely cause of post-gastrectomy esophagitis resistant to medical treatment.
- A 45 cm Roux-en-Y gastroenterostomy conversion is an effective treatment for eradicating esophagitis symptoms in this patient population.
- Roux-en-Y conversion specifically addresses the esophageal pathology without significantly altering other common post-gastrectomy symptoms.