Comparison Of Esophageal Acid And Alkaline Exposure Characteristics Between Patients With Adenocarcinoma Of The Esophagogastric Junction After Proximal Gastrectomy And Total Gastrectomy

Background and Objective:Cardia carcinoma is still using comprehensive treatment based on surgery. It is destruction of anti-reflux mechanism that inevitablely cause esophageal reflux. To compare the esophageal acid and alkaline exposure characteristics of patients with cardia carcinoma after proximal gastrectomy and total gastrectomy.Methods:A total of 77 patients with cardia carcinoma who underwent radical surgery therapy from Sep.2007 to Sep.2011 in our hospital were retrospectively reviewed. Twenty-four-hour esophageal pH monitoring were performed in all patients.Results:All patients were divided into three groups:group TG had total gastrectomy(n=25), group PP had proximal gastrectomy with pylorus forming(n=33) and group NP had proximal gastrectomy with non-pylorus forming(n=19). It revealed that indicators of acid reflux including the total times of acid episodes,> 5min times of acid episodes, duration of longest acid episodes, total period of pH<4.00 and the DeMeester Scores in group NP were significantly higher than in group PP(U=32, P< 0.01;U=35, P<0.01;U=23, P<0.01;U=39, P<0.01;U=49, P<0.01 respectively). Only alkline reflux was observed in group TG The total times of alkaline episodes in PP group is significantly lower than in group TG(U=52, P<0.01) and group NP(U=182, P<0.01).>5min times of alkaline episodes in group TG is larger than in group PP, and that in group PP is larger than in group NP (P<0.01). Duration of longest alkaline episodes and total period of pH>7.00 in group PP is significantly higher than in group TG(U=125, P<0.01), and that in group TG is higher than in group NP (U=143.5,P<0.01)Conclusion:Alkaline reflux should be evaluated by duration of longest alkaline episodes and total period of pH>7.00, while the index reflecting frequency of reflux is not accurate in evaluating real situation in alkaline situation. Alkaline reflux deserves more attention in evaluating esophageal reflux in patients with cardia carcinoma after resection. The application of pylorus-forming is not helpful to relieving esophageal acid episodes for it may lead to more severe alkaline reflux.