Postoperative Reflux Oesophagitis

Abstract

The postoperative syndrome of reflux oesophagitis is now being more frequently recognised in patients after gastric surgery, owing to the development of modern gastro-intestinal endoscopy. Scott and Longmire [1] recognised in 1949 that heartburn and dysphagia were frequent after total gastrectomy. They attributed these symptoms to regurgitation of bile and pancreatic juice into the oesophagus. It was later reported by Longmire and Beal [2] and by Helsingen [3] that reconstruction of a Braun entero-anastomosis between the afferent and efferent limbs of the oesophagojejunostomy resulted in reduced incidence of oesophageal reflux symptoms. Helsingen [3] reported in 1959, in a follow-up examination of nine patients who had undergone total gastrectomy 5 years previously, the presence of mild to moderate oesophagitis in eight of the nine patients. The frequency with which oesophageal stenosis occurs after oesophagogastric operations had already been pointed out by Barrett and Franklin [4] and Ripley et al. [5]. The occurrence of oesophageal strictures after uncomplicated partial gastrectomy had been reported by Douglas [6] and McKeown [7] and oesophageal strictures after partial gastrectomy with complications had been reported by Benedict and Daland [8] and Craighead [9]. Oesophageal strictures after gastrojejunostomy had been reported by several other authors [10–15].