The gastro-oesophageal junction before and after operations for duodenal ulcer.

Thirty-seven patients with duodenal ulceration were studied with oesophageal manometry preoperatively and then again 6-12 months after operation. In 28 patients who had been treated by truncal vagotomy and either a pyloroplasty or a gastroenterostomy the length of the zone of elevated pressure at the gastro-oesophageal junction was reduced, although the maximum pressure was unchanged. In 9 patients who had had a Polya partial gastrectomy the zone was also shortened, but there was a significant fall in the maximum pressure as well. It is suggested that this reduction of the resting pressure in the sphincter may account for the gastro-oesophageal reflux which is frequently seen after a Polya partial gastrectomyj and may be caused by low circulating gastrin levels since the antrum has been removed.