Surgical management of reflux esophagitis associated with duodenal ulcer

The prevalence of associated reflex esophagitis and the effects of surgery for ulcer on coexistent esophagitis were assessed in 687 patients operated on for duodenal or pyloric ulcer. Eighty-one patients (12%) had a preoperative endoscopic diagnosis of reflux esophagitis. The association resulted to be more frequent in patients with pyloric or bulbar stenosis than in patients without stenosis (20% vs 5%, p = 0.000001). Billroth II gastric resection, performed in most cases, caused the healing or the improvement of esophagitis in 95% of cases as demonstrated at endoscopy 6 months after surgery, particularly in 98% of patients with pyloric or bulbar stenosis and in 80% of patients without stenosis (p = 0.05). Therefore, gastric resection, eliminating the main pathogenetic factors of reflux esophagitis associated with pyloric or bulbar stenosis (gastric acid hypersecretion, impaired gastric emptying), assures the healing of esophagitis in most cases. However, anomalies in Lower Esophageal Sphincter function might play an important role in the pathogenesis of reflux esophagitis in duodenal ulcer patients without stenosis. In these patients, on the basis of manometric and pH monitoring data, it may be useful to associate an anti-reflux procedure or a duodenal diversion with a gastric resection in presence of Lower Esophageal Sphincter hypotonia.