Department of Surgery, Kurume University School of Medicine.
Division of Biomedical Statistics, Department of Integrated Medicine, Graduate School of Medicine, Osaka University.
Kurume Med J. 2023 Jul 3;68(2):91-96. doi: 10.2739/kurumemedj.MS682005. Epub 2023 Mar 31.
Reflux esophagitis and gastric tube ulcer sometimes cause severe clinical problems in patients undergoing esophagectomy with gastric tube reconstruction. We previously reported that acidity in the gastric tube was decreased for 1 year after esophagectomy, and that lower acidity levels were associated with Helicobacter pylori (H. pylori) infection. However, the long-term changes in gastric acidity remain unknown. We aimed to investigate the long-term changes in gastric acidity after surgery. Eighty-nine patients who underwent esophagectomy with gastric tube reconstruction for esophageal cancer were analyzed. They underwent 24-hour pH monitoring, serum gastrin measurement, and H. pylori infection examination before surgery, at 1 month, 1 year, and 2 years after surgery. The gastric acidity at 1 month and 1 year after surgery was significantly lower than that before surgery (p=0.003, p=0.003). However, there was no difference in gastric acidity before and 2 years after surgery. The gas tric acidity in H. pylori-infected patients was significantly lower in comparison to non-infected patients at each time point (p=0.0003, p<0.0001, p<0.0001, p<0.0001, respectively). In H. pylori-infected patients, gastric acid ity was decreased for 1 year after surgery, and recovered within 2 years after surgery. However, no significant differences were observed in the acidity levels of non-infected patients during the 2-year follow-up period. The serum gastrin level increased after esophagectomy. The acidity levels in the gastric tube recovered within 2 years after surgery. Periodic endoscopy examination is recommended for early detection of acid-related disease, such as reflux esophagitis or gastric tube ulcer, after esophagectomy with gastric tube reconstruction.
胃食管反流和胃管溃疡有时会导致接受胃管重建食管切除术的患者出现严重的临床问题。我们之前曾报道，食管切除术后胃管的酸度会在 1 年内下降，较低的酸度水平与幽门螺杆菌（H. pylori）感染有关。然而，胃酸度的长期变化尚不清楚。我们旨在研究手术后胃酸度的长期变化。分析了 89 例接受胃管重建食管切除术治疗食管癌的患者。他们在手术前、手术后 1 个月、1 年和 2 年分别进行了 24 小时 pH 监测、血清胃泌素测量和 H. pylori 感染检查。手术后 1 个月和 1 年的胃酸度明显低于手术前（p=0.003，p=0.003）。然而，手术后 2 年与手术前的胃酸度无差异。与非感染患者相比，H. pylori 感染患者在各个时间点的胃酸度均显著降低（p=0.0003，p<0.0001，p<0.0001，p<0.0001）。在 H. pylori 感染患者中，胃酸度在手术后 1 年内下降，并在手术后 2 年内恢复。然而，在非感染患者中，在 2 年的随访期间，酸度水平没有显著差异。手术后血清胃泌素水平升高。胃管酸度在手术后 2 年内恢复。建议在胃管重建食管切除术后进行定期内镜检查，以早期发现与胃酸相关的疾病，如胃食管反流或胃管溃疡。
