Department of Surgery, Escola Paulista de Medicina, Federal University of São Paulo, São Paulo, Brazil.
Surg Endosc. 2011 Oct;25(10):3198-201. doi: 10.1007/s00464-011-1688-z. Epub 2011 Apr 13.
An unbuffered postprandial proximal gastric acid pocket (PPGAP) has been noticed in normal individuals and patients with gastroesophageal reflux disease (GERD). The role of gastric anatomy in the physiology of the PPGAP remains unclear. It is also unclear whether change in the PPGAP may contribute to GERD control. This study aims to analyze the presence of PPGAP in patients submitted to Nissen fundoplication.
Fifteen patients who had a laparoscopic Nissen fundoplication (mean age = 61 years, 13 females, mean time from operation 1 year) were studied. All patients were free of foregut symptoms. Patients underwent high-resolution manometry to identify the location of the lower border of the lower esophageal sphincter (LBLES).Station pull-through pH monitoring was performed from 5 cm below the LBLES to the LBLES in increments of 1 cm in a fasting state and 10 min after a standardized fatty meal.
Four patterns of gastric acidity were found: (1) acid was not detected in the studied area of the stomach in 8 (53%) patients; (2) constant acidity (stomach is not alkalinized after meal), i.e., a buffered layer was not found in 3 (20%) patients; (3) PPGAP was not detected, i.e., the whole stomach is alkalinized, in 1 (7%) patient; and (4) PPGAP was noted in 3 (20%) patients with extensions of 2, 2, and 5 cm.
PPGAP is present in a minority of patients after Nissen fundoplication. This finding may explain part of the GERD control and that the gastric fundus may play a role in the genesis of the PPGAP.
在正常人和胃食管反流病（GERD）患者中，都观察到未缓冲的餐后近端胃腔酸袋（PPGAP）。胃解剖结构在 PPGAP 生理学中的作用尚不清楚。PPGAP 的变化是否有助于 GERD 的控制也不清楚。本研究旨在分析接受 Nissen 胃底折叠术的患者中 PPGAP 的存在情况。
研究了 15 例接受腹腔镜 Nissen 胃底折叠术的患者（平均年龄=61 岁，女性 13 例，手术时间平均 1 年）。所有患者均无消化道症状。患者接受高分辨率测压以确定食管下括约肌（LES）下边界（LBLES）的位置。空腹和标准脂肪餐后 10 分钟，从 LBLES 下 5cm 到 LBLES 以 1cm 为间隔进行站拉式 pH 监测。
发现了 4 种胃酸度模式：（1）8 例（53%）患者胃研究区域未检测到胃酸；（2）持续酸度（餐后胃未碱化），即 3 例（20%）患者未发现缓冲层；（3）PPGAP 未检测到，即整个胃均碱化，1 例（7%）患者；（4）3 例（20%）患者存在 PPGAP，延伸分别为 2cm、2cm 和 5cm。
Nissen 胃底折叠术后少数患者存在 PPGAP。这一发现可以解释部分 GERD 控制的原因，并且胃底可能在 PPGAP 的发生中起作用。
