Objectives: Partial gastrectomy patients with anatomic alterations to the pylorus and acid secretion are excellent models for studying the controversial role of duodenogastric reflux in producing esophageal symptoms and esophagitis.
Methods: We studied 13 partial gastrectomy patients who had recent upper gastrointestinal endoscopies and chronic duodenogastric reflux symptoms. Simultaneously, acid and duodenogastric reflux were assessed by ambulatory 24-h esophageal pH and bilirubin monitoring. Abnormal values for both acid and bilirubin reflux were defined by previous studies of healthy volunteers from our laboratory. Symptoms were recorded and correlated with acid and duodenogastric reflux episodes.
Results: Mean percent time bilirubin reflux for the entire group was 26.8 +/- 7.2% (range 0.4-91.2%), whereas mean percent total acid reflux was 4.6 +/- 2.4% (range 0.0-26.1%). Ten (77%) patients had abnormal duodenogastric reflux, but three patients (23%) also had associated abnormal acid reflux. Only these three patients had esophagitis, two ulcerative and one Barrett's esophagus. A total of 75 symptoms (36 heartburn, 33 epigastric pains, three regurgitation, two nausea/vomiting, one abdominal distension) were reported; 65% were acid related. Of patients with heartburn and regurgitation, 97% were associated with acid reflux episodes.
Conclusions: Although excessive amounts of duodenogastric reflux are common in partial gastrectomy patients, esophagitis and Barrett's esophagus are seen only in patients with concomitant acid reflux, and most esophageal symptoms are acid related. Therefore, acid rather than duodenogastric reflux is the main culprit in this syndrome and should be aggressively treated.