The use of oesophageal pH-monitoring for the evaluation of gastrooesophageal reflux after resection of the cardia and total gastrectomy.

We intended to estimate the applicability of oesophageal pHmetry for the evaluation and diagnosis of reflux oesophagitis after resection of the cardia and total gastrectomy. We applied the system of glass calomel electrode type GK 282 C (Radiometer-Kopenhagen). The pH probe was introduced transnasally in the remnant of the stomach or into the jejunum. Its position was controlled by fluoroscopy. Then the probe was drawn for 5 cm subsequently to the final position of 5 to 10 cm above the oesophagogastric or oesophagojejunal anastomosis. During the examination the patients were sitting or lying backward. Afterwards the reflux was provocated by Valsalva's and Müller's maneuvers and in head down position. If necessary the patient swallowed 50 cc. of 0,1 N HCl solution. We examined 37 patients. Among 29 patients after gastrooesophageal resection the reflux was stated in 18 cases (in 6 cases faint in 3 moderate and in 9 severe). The proof of the reflux failed in all 8 cases after total gastrectomy. In these cases the method is unsuitable for the evaluation of jejunooesophageal reflux because of a too fast passage of the swallowed 0,1 N HCl solution through the jejunum. It prevents the creation of the necessary acidity gradient between the oesophagus and the jejunum during the examination. We proved by this method the reflux in 14 out of 24 patients with regurgitation in the history and in 4 out of 11 without it. We consider the method to be safe, simple and successful in the assessment of gastrooesophageal reflux which must be evaluated in combination with the results of clinical, X-ray and endoscopical examinations.