Combined 24-hour intraluminal pH and bile monitoring of the denervated whole stomach as an esophageal substitute.

Abstract

BACKGROUND/AIMS:

The study aims to evaluate the pH and the presence of bile in the denervated whole stomach pulled up to the neck after subtotal esophagectomy.

METHODOLOGY:

The pH and the presence of bile in the gastric cavity were monitored by combined 24-hour pH and bilimetry in 16 patients having their whole stomach as an esophageal substitute (i.e., 8 with and 8 without a gastric drainage procedure) and in 25 healthy control subjects. The percentage of time during which pH was < 2 as well as the percentage of time during which bile absorbance was > 0.25 for the total, upright, and supine periods of recording were considered for each subject studied. Seven patients underwent a gastroscopy with biopsies.

RESULTS:

Intragastric acidity was normal in 50% of patients while it was reduced in the other 50%. Ten of the 16 patients (62.5%), i.e., 4 with (50%) and 6 without (75%) a drainage procedure, had excessive exposure of the gastric mucosa to bile. No significant correlation was found between the existence of a high intraluminal pH profile and excessive bile exposure (p = 0.9163). Bile exposure was significantly higher in whole stomach patients than in controls in both the upright and supine positions, irrespective of the existence or absence of a drainage procedure (p ranging from 0.0272-0.0001). Bile exposure in the supine position tended to be longer in patients without than in those with a drainage procedure (p = 0.0929). Helicobacter pylori-negative chemical gastritis was present in 3 of the 7 patients who underwent a gastroscopy, all 3 having excessive bile exposure and no food retention in the transplant lumen.

CONCLUSIONS:

Gastric denervation and transposition up to the neck increased exposure of the gastric mucosa to bile, irrespective of the patient's position and of the presence of a gastric drainage procedure. The absence of gastric drainage procedure tends to ensure exposure to bile prolongeLow gastric acidity, if present, is due to a reduction in acid secretion rather than to a buffering effect from duodenal juice having refluxed. Gastritis is more likely to be related to excessive exposure of the gastric mucosa to bile than to food retention.

• Authors: R Romagnoli, P Bechi, M Salizzoni, J M Collard
• Journal: Hepato-gastroenterology (Hepatogastroenterology) Vol. 46 Issue 25 Pg. 86-91 ( 1999) ISSN: 0172-6390 [Print] Greece
• PMID: 10228769 (Publication Type: Journal Article)

Topics

• Adult
• Aged
• Bile (chemistry)
• Bile Reflux (physiopathology)
• Denervation
• Esophagectomy
• Female
• Gastritis (physiopathology)
• Gastroscopy
• Humans
• Hydrogen-Ion Concentration
• Male
• Middle Aged
• Monitoring, Physiologic
• Postoperative Period
• Stomach (chemistry, innervation, transplantation)