Endoscopic Alkaline Reflux Gasitritis and Esophagitis in Gastroresected Patients: Clinical significance and difference according to the types of surgery

Jung, Jun Oh; Kim, You Sun; Moon, Sun Hi; Hwang, Jin Hyok; Woo, Gwang Hoon; Kim, Jin; Chang, Dong Kyung; Jung, Hyun Chae; Song, In Sung; Choi, Kyoo Wan; Kim, Chung Yong

Abstract

BACKGROUND/AIMS: The reflux alkaline gastritis and esophagitis are important late complications after gastric surgery. Endoscopy is primary diagnostic tool for them. But, the clinical significance of gastritis and esophagitis diagnosed by endoscopy is not well known. We evaluated the correlation between the alkaline reflux gastritis and esophagitis and their symptoms and we also examined their prevalence according to types of surgery.
METHODS
The 111 gastroresected patients who had had upper endoscopy by one endoscopist were evaluated. We reviewed all their medical records, and interviewed 54 patients by telephone to evaluate symptoms.
RESULTS
Endoscopic reflux alkaline gastritis was observed in 38 patients(45%) with Billroth-II gastrectomy and in 4 patients(33%) with Bil]roth-I gastrectomy. But, there was no symptomatic difference between group with and without endoscopic reflux gastritis. Moreover, none of them had typical reflux gastritis symptom complex including billous vomiting. In all patients with total gastrectomy and loop esophagojejunostomy, endoscopic reflux esophagitis was observed. But, there was no case af endoscopic reflux esophagitis in the patients with total gastrectomy and Roux-en-Y anastomosis. There was significant symptomatic correlation between group with and without endoscopic reflux esophagitis. T'he incidence of reflux esophagitis had no difference between Billroth-II gastrectomy and Billroth-I gastrectomy.
CONCLUSION
The endoscopic alkaline reflux gastritis had poor symptematic correlation. In the case of total gastrectomy, for the prevention of reflux esophagitis, Roux-en-Y anastomosis is better than loop esophagojejunostomy.