BACKGROUND AND PURPOSE: The role of duodenogastroesophageal reflux (DGER) in gastroesophageal reflux disease (GERD) remains controversial. Few studies of reflux have compared patients with an intact stomach to those without intact stomach after gastroesophageal surgery. This study aimed to investigate differences of the refluxate between patients with and without prior gastroesophageal surgery and to assess the role of DGER in GERD. METHODS: One hundred patients (34% with reflux symptoms) were divided into four groups: 23 with an intact stomach, and 27, 42, and 8 with esophagectomy followed by gastric tube reconstruction, distal gastrectomy, and total gastrectomy, respectively. Reflux symptoms were evaluated, and endoscopy and simultaneous 24-h monitoring of esophageal pH and bilirubin were performed. RESULTS: Of 44 patients with increased DGER but without increased acid reflux, three had severe reflux esophagitis and seven had Barrett's esophagus. DGER was most frequent under weakly acidic conditions in the intact stomach, esophagectomy, and distal gastrectomy groups. Pure acid reflux and DGER at any pH were elevated in GERD patients with an intact stomach, while weakly acidic and alkaline DGER were elevated in GERD patients after gastrectomy. Esophagectomy patients had reflux with the combined characteristics of those in the intact stomach and gastrectomy groups. Weakly acidic or alkaline DGER was correlated with symptoms and esophageal mucosal changes in gastrectomy patients. CONCLUSION: The refluxate causing GERD differed between patients with and without prior gastroesophageal surgery. Weakly acidic or alkaline DGER may cause both symptoms and esophageal mucosal damage.
BACKGROUND AND PURPOSE: The role of duodenogastroesophageal reflux (DGER) in gastroesophageal reflux disease (GERD) remains controversial. Few studies of reflux have compared patients with an intact stomach to those without intact stomach after gastroesophageal surgery. This study aimed to investigate differences of the refluxate between patients with and without prior gastroesophageal surgery and to assess the role of DGER in GERD. METHODS: One hundred patients (34% with reflux symptoms) were divided into four groups: 23 with an intact stomach, and 27, 42, and 8 with esophagectomy followed by gastric tube reconstruction, distal gastrectomy, and total gastrectomy, respectively. Reflux symptoms were evaluated, and endoscopy and simultaneous 24-h monitoring of esophageal pH and bilirubin were performed. RESULTS: Of 44 patients with increased DGER but without increased acid reflux, three had severe reflux esophagitis and seven had Barrett's esophagus. DGER was most frequent under weakly acidic conditions in the intact stomach, esophagectomy, and distal gastrectomy groups. Pure acid reflux and DGER at any pH were elevated in GERDpatients with an intact stomach, while weakly acidic and alkaline DGER were elevated in GERDpatients after gastrectomy. Esophagectomy patients had reflux with the combined characteristics of those in the intact stomach and gastrectomy groups. Weakly acidic or alkaline DGER was correlated with symptoms and esophageal mucosal changes in gastrectomy patients. CONCLUSION: The refluxate causing GERD differed between patients with and without prior gastroesophageal surgery. Weakly acidic or alkaline DGER may cause both symptoms and esophageal mucosal damage.
Authors: D Armstrong; J R Bennett; A L Blum; J Dent; F T De Dombal; J P Galmiche; L Lundell; M Margulies; J E Richter; S J Spechler; G N Tytgat; L Wallin Journal: Gastroenterology Date: 1996-07 Impact factor: 22.682
Authors: Ulrich Peitz; Michael Vieth; Matthias Ebert; Stefan Kahl; Hans-Ulrich Schulz; Albert Roessner; Peter Malfertheiner Journal: Am J Gastroenterol Date: 2005-09 Impact factor: 10.864
Authors: J M O'Riordan; O N Tucker; P J Byrne; G S A McDonald; N Ravi; P W N Keeling; J V Reynolds Journal: Am J Gastroenterol Date: 2004-02 Impact factor: 10.864
Authors: Ayman O Nassr; Syeda Nadia Shah Gilani; Mohammed Atie; Tariq Abdelhafiz; Val Connolly; Neil Hickey; Thomas Noel Walsh Journal: J Gastrointest Surg Date: 2011-04-12 Impact factor: 3.452