Mori N, Fujita H, Sueyoshi S, Aoyama Y, Yanagawa T, Shirouzu K
Department of Surgery, Kurume University School of Medicine, Kurume, Fukuoka 830-0011, Japan.
Dis Esophagus. 2007;20(4):333-40. doi: 10.1111/j.1442-2050.2007.00718.x.
It is commonly considered that acidity in a gastric tube used as an esophageal substitute after esophagectomy decreases due to truncal vagotomy. However, there have been few, if any, studies on the factors influencing the acidity in the gastric tube. It is well known that Helicobacter pylori (H. pylori) plays an important role in acid secretion of the stomach. The aim of this study was to investigate whether or not H. pylori infection also influenced the acidity in the gastric tube as an esophageal substitute. We investigated the changes in the levels of gastric acidity and the status of H. pylori infection from the preoperative period to 1 year after surgery. In 65 Japanese patients who underwent resection of esophageal cancer followed by reconstruction using a gastric tube, 24-h gastric pH monitoring and examination of H. pylori infection using the 13C-urea breath test and biopsy specimen obtained from the gastric mucosa under upper gastrointestinal endoscopy were performed pre- and postoperatively. Twenty-seven among the 65 patients underwent the same examinations at 1 year after surgery. The levels of postoperative gastric acidity and at 1 year after surgery were significantly lower than that of preoperative gastric acidity (P = 0.031, P = 0.001, respectively). There was no difference in the levels of gastric acidity between 1.5 months and 1 year after surgery (P = 0.282). The levels of gastric acidity in the stomach and in the gastric tube were significantly influenced by H. pylori infection, while age, gender, and past history of peptic ulcer showed no influence. The level of gastric acidity in patients who had H. pylori infection pre- and postoperatively were significantly lower than that in patients who had no H. pylori infection pre- and postoperatively (P < 0.0001). H. pylori infection was indicated to be an important factor influencing the levels of gastric acidity in the reconstructed esophagus as well as in the stomach before surgery.
人们普遍认为，在食管切除术后用作食管替代物的胃管中，由于迷走神经干切断术，胃酸度会降低。然而，关于影响胃管酸度的因素的研究即便有也很少。众所周知，幽门螺杆菌（H. pylori）在胃的胃酸分泌中起重要作用。本研究的目的是调查幽门螺杆菌感染是否也会影响用作食管替代物的胃管的酸度。我们调查了从术前到术后1年胃酸度水平的变化以及幽门螺杆菌感染状况。在65例接受食管癌切除并使用胃管重建的日本患者中，术前和术后进行了24小时胃pH监测，并使用13C-尿素呼气试验和上消化道内镜下从胃黏膜获取的活检标本检测幽门螺杆菌感染情况。65例患者中有27例在术后1年进行了相同的检查。术后胃酸度水平和术后1年的胃酸度水平均显著低于术前胃酸度水平（分别为P = 0.031，P = 0.001）。术后1.5个月至1年之间胃酸度水平无差异（P = 0.282）。胃和胃管中的胃酸度水平受幽门螺杆菌感染的显著影响，而年龄、性别和消化性溃疡病史则无影响。术前和术后均有幽门螺杆菌感染的患者的胃酸度水平显著低于术前和术后均无幽门螺杆菌感染的患者（P < 0.0001）。幽门螺杆菌感染被认为是影响重建食管以及术前胃的胃酸度水平的重要因素。
