Hedberg Jakob, Hedenström Hans, Nilsson Sven, Sundbom Magnus, Gustavsson Sven
Department of Surgery, University Hospital, Uppsala, Sweden.
Obes Surg. 2005 Nov-Dec;15(10):1375-8. doi: 10.1381/096089205774859380.
The pathogenetic mechanisms of stomal ulcer after Roux-en-Y gastric bypass (RYGBP) are unclear. In order to study the role of gastric acid, we measured acidity in the proximal pouch using a pH-sensitive probe.
6 patients (5 females, mean age 45 years old at time of operation) with endoscopically confirmed stomal ulcer, were studied 2 to 6 years after RYGBP. All complained of epigastric pain that improved during proton pump inhibitor (PPI) therapy. Control subjects were 6 females (50 years old) who had had RYGBP at least 5 years earlier and denied symptoms of epigastric pain or heartburn. The pH-sensitive probe (Digitrapper-pH, Medtronic) was passed through the nose to the proximal pouch, guided by the calculated distance and pH response. The probe was left in place for 4 hours. The percentage of time with pH <4 was calculated.
The probe could be accurately positioned in the proximal pouch both in symptomatic patients and in controls as evidenced by the acid pH reaction. The proximal pouches of patients with stomal ulcer were significantly more exposed to acid compared to controls. The median percentage of time with pH <4 was 69% and 20% in the stomal ulcer and the control group, respectively (P<0.01). Barium follow-through excluded gastro-gastric fistula in stomal ulcer patients.
RYGBP patients with stomal ulcer have increased acid production in their proximal pouch in comparison with asymptomatic RYGBP patients. Gastric acid appears to have an important role in the pathogenesis of stomal ulcer.
Roux-en-Y胃旁路术（RYGBP）后吻合口溃疡的发病机制尚不清楚。为了研究胃酸的作用，我们使用pH敏感探头测量了近端胃囊的酸度。
对6例经内镜确诊为吻合口溃疡的患者（5例女性，手术时平均年龄45岁）进行研究，这些患者在RYGBP术后2至6年。所有患者均主诉上腹部疼痛，在质子泵抑制剂（PPI）治疗期间有所改善。对照组为6例女性（50岁），她们至少在5年前接受了RYGBP，且否认有上腹部疼痛或烧心症状。将pH敏感探头（Digitrapper-pH，美敦力公司）经鼻插入近端胃囊，根据计算出的距离和pH反应进行引导。探头留置4小时。计算pH<4的时间百分比。
通过酸pH反应证明，探头在有症状患者和对照组的近端胃囊中均能准确定位。与对照组相比，吻合口溃疡患者的近端胃囊明显更易暴露于酸性环境。吻合口溃疡组和对照组pH<4的时间中位数分别为69%和20%（P<0.0１）。钡剂造影排除了吻合口溃疡患者存在胃-胃瘘。
与无症状的RYGBP患者相比，患有吻合口溃疡的RYGBP患者近端胃囊的酸分泌增加。胃酸似乎在吻合口溃疡的发病机制中起重要作用。
