Contribution of acid and duodenogastro- oesophageal reflux to oesophageal mucosal injury and symptoms in partial gastrectomy patients

Background—The role of acid and pepsin in causing symptoms and oesophagitis is well established; however, the significance of duodenogastro-oesophageal reflux (DGOR) in this disorder is unclear. Aims—To understand the role of acid and DGOR in causing upper gastrointestinal (GI) symptoms and oesophageal mucosal injury in partial gastrectomy (PG) patients. Methods—Thirty two PG patients with upper GI symptoms were studied. Twenty four hour ambulatory acid and bilirubin measurements were obtained with Bilitec 2000 using glass electrode and fibreoptic sensor. Upper GI symptoms and oesophagitis were correlated with either acid or DGOR. Results—The PG patients were a heterogeneous group: 28% (9/32) had mixed reflux (acid+/DGOR+); 50% (16/32) had only DGOR (acid−/DGOR+); and 22% (7/32) had neither (acid−/DGOR−). Upper GI symptoms were associated with both mixed reflux (69%) and DGOR (24%). Six patients (67%) in the acid+/DGOR+ group had oesophagitis; no acid−/DGOR+ or acid−/DGOR− patients had oesophagitis. Mixed reflux showed a significant (p<0.0001) association with oesophagitis, while DGOR did not (p=0.3). Conclusions—(1) The majority of upper GI symptoms and all cases of oesophagitis in the PG patients occurred in patients who had mixed refluxate (acid and DGOR); (2) DGOR without simultaneous acid reflux may cause symptoms, but was not associated with oesophagitis in this patient group. (Gut 1997; 41: 297–302)