The thoracic stomach: a study of gastric emptying, bile reflux and mucosal change

The clinical progress, histological state of the gastric mucosa, gastric emptying of a liquid meal and duodenogastric reflux were studied postoperatively in 15 patients with a vagotomized intrathoracic stomach without a drainage procedure. The intact though denervated pylorus did not impede the emptying of liquids. Bile reflux into the thoracic stomach in both the erect and supine positions was significantly greater than that measured in control subjects. While posture did not affect duodenogastric reflux in the normal adult, bile reflux across the denervated pylorus was significantly increased in the supine position. Chronic active gastritis was noted in 12 patients but could not be correlated with the degree of bile reflux. Nine patients had evidence of pulmonary aspiration and gastric food residue was a common finding at endoscopy. The vagotomized intrathoracic stomach may need a drainage procedure to facilitate solid emptying.