Okuyama Manabu, Motoyama Satoru, Maruyama Kiyotomi, Sasaki Kenji, Sato Yusuke, Ogawa Jun-ichi
Department of Surgery, Akita University School of Medicine, Hondo, Akita City, 010-8543, Japan.
World J Surg. 2008 Feb;32(2):246-54. doi: 10.1007/s00268-007-9325-7.
Denervated stomach used as an esophageal substitute after esophagectomy often retains or spontaneously recovers acid production. The aims of the present study were to assess the relationship between esophageal acid exposure or gastric acidity and reflux-related symptoms after esophagectomy, and to assess the ability of proton pump inhibitors (PPIs) to relieve gastroesophageal reflux-related symptoms.
Forty-four patients underwent esophageal and gastric 24-h pH monitoring early after esophagectomy with gastric reconstruction. Initially, patients with both gastric acidity and reflux symptoms were treated with PPIs (Treatment group), then all patients with gastric acidity, whether symptomatic or not, were treated (Prevention group). Reflux-related symptoms were correlated with esophageal acid exposure and postoperative gastric acidity. Gastric acidity was then correlated with serum anti-Helicobacter pylori immunoglobulin G (IgG) titers and preoperative endoscopic findings
Sixteen patients (36.4%) reporting reflux and showing gastric acid production were treated with PPIs, which provided relief to 13 (81.3%). Although symptoms did not correlate with the esophageal acid exposure, postoperative gastric acidity was significantly greater among patients who were symptomatic than among those who were not. Overall, acid production was lower in older patients (>64 years of age), although older patients who were H. pylori-negative and without chronic atrophic gastritis also showed high levels of gastric acidity.
Proton pump inhibitors should be administered prophylactically early after esophagectomy to relieve and prevent reflux-related symptoms. Candidates for preventive therapy include those less than 64 years of age or older patients who are H. pylori-negative and without chronic atrophic gastritis.
食管切除术后用作食管替代物的去神经胃常保留或自发恢复胃酸分泌。本研究的目的是评估食管切除术后食管酸暴露或胃酸度与反流相关症状之间的关系，以及评估质子泵抑制剂（PPI）缓解胃食管反流相关症状的能力。
44例患者在食管切除术后早期行食管和胃24小时pH监测并进行胃重建。最初，对有胃酸分泌且有反流症状的患者用PPI治疗（治疗组），然后对所有有胃酸分泌的患者，无论有无症状，均进行治疗（预防组）。将反流相关症状与食管酸暴露及术后胃酸度进行关联分析。然后将胃酸度与血清抗幽门螺杆菌免疫球蛋白G（IgG）滴度及术前内镜检查结果进行关联分析。
16例（36.4%）报告有反流且有胃酸分泌的患者接受了PPI治疗，其中13例（81.3%）症状得到缓解。虽然症状与食管酸暴露无相关性，但有症状患者的术后胃酸度明显高于无症状患者。总体而言，老年患者（>64岁）胃酸分泌较低，不过幽门螺杆菌阴性且无慢性萎缩性胃炎的老年患者胃酸度也较高。
食管切除术后应尽早预防性应用质子泵抑制剂，以缓解和预防反流相关症状。预防性治疗的候选人群包括年龄小于64岁的患者或幽门螺杆菌阴性且无慢性萎缩性胃炎的老年患者。
