Gotley D C, Ball D E, Owen R W, Williamson R C, Cooper M J
University Department of Surgery, Bristol Royal Infirmary, U.K.
Surgery. 1992 Jan;111(1):29-36.
Among 51 patients with refractory symptomatic reflux esophagitis seen during an 18-month period, 8 (16%) had undergone previous partial gastrectomy. Either Billroth II (n = 6) or Billroth I (n = 2) resection had been carried out for peptic ulceration 18 months to 30 years beforehand. Each patients was evaluated by symptom scoring, endoscopy, and 24-hour pH monitoring plus a 16-hour esophageal aspiration study, in which 2-hourly aliquots were measured for acid, pepsin, conjugated and unconjugated bile acids, and trypsin. After conversion to a 45 cm Roux-en-Y gastroenterostomy, symptom scoring and endoscopy were repeated at 6 to 12 months in all eight patients. Pepsin, acid, and unconjugated bile acids were seldom present in esophageal aspirates. Conjugated bile acids in concentrations up to 30 mmol/L and trypsin up to 428 micrograms/ml were found in cases of severe esophagitis, mostly during nocturnal rest. Esophagitis, heartburn, regurgitation, and bilious vomiting were eradicated by Roux-en-Y conversion, but other postgastrectomy symptoms (early satiety, dumping, epigastric pain, and diarrhea) were largely unchanged. Postgastrectomy esophagitis resistant to medical therapy seems likely to be caused by nocturnal exposure to trypsin and conjugated bile acids; it is well controlled by a 45 cm Roux-en-Y conversion.
在18个月期间诊治的51例难治性症状性反流性食管炎患者中，8例（16%）曾接受过部分胃切除术。均因消化性溃疡于18个月至30年前进行了毕Ⅱ式（n = 6）或毕Ⅰ式（n = 2）切除术。对每位患者进行症状评分、内镜检查、24小时pH监测以及16小时食管抽吸研究，其中每2小时测量一次抽吸液中的酸、胃蛋白酶、结合型和非结合型胆汁酸以及胰蛋白酶。在改行45 cm Roux-en-Y胃空肠吻合术后，对所有8例患者在6至12个月时重复进行症状评分和内镜检查。食管抽吸物中很少出现胃蛋白酶、酸和非结合型胆汁酸。在严重食管炎患者中，大多在夜间休息时，发现结合型胆汁酸浓度高达30 mmol/L，胰蛋白酶浓度高达428 μg/ml。Roux-en-Y改道术根除了食管炎、烧心、反流和胆汁性呕吐，但其他胃切除术后症状（早饱、倾倒综合征、上腹痛和腹泻）基本未变。胃切除术后对药物治疗耐药的食管炎似乎是由夜间接触胰蛋白酶和结合型胆汁酸所致；45 cm Roux-en-Y改道术能很好地控制该病。
