Postprandial proximal gastric acid pocket in patients after laparoscopic Nissen fundoplication
- 149 Downloads
An unbuffered postprandial proximal gastric acid pocket (PPGAP) has been noticed in normal individuals and patients with gastroesophageal reflux disease (GERD). The role of gastric anatomy in the physiology of the PPGAP remains unclear. It is also unclear whether change in the PPGAP may contribute to GERD control. This study aims to analyze the presence of PPGAP in patients submitted to Nissen fundoplication.
Fifteen patients who had a laparoscopic Nissen fundoplication (mean age = 61 years, 13 females, mean time from operation 1 year) were studied. All patients were free of foregut symptoms. Patients underwent high-resolution manometry to identify the location of the lower border of the lower esophageal sphincter (LBLES).Station pull-through pH monitoring was performed from 5 cm below the LBLES to the LBLES in increments of 1 cm in a fasting state and 10 min after a standardized fatty meal.
Four patterns of gastric acidity were found: (1) acid was not detected in the studied area of the stomach in 8 (53%) patients; (2) constant acidity (stomach is not alkalinized after meal), i.e., a buffered layer was not found in 3 (20%) patients; (3) PPGAP was not detected, i.e., the whole stomach is alkalinized, in 1 (7%) patient; and (4) PPGAP was noted in 3 (20%) patients with extensions of 2, 2, and 5 cm.
PPGAP is present in a minority of patients after Nissen fundoplication. This finding may explain part of the GERD control and that the gastric fundus may play a role in the genesis of the PPGAP.
KeywordsGastroesophageal reflux Acid pocket Nissen fundoplication
We are indebted to Ms. Mirian Wolfarth for her invaluable technical assistance with the esophageal tests. This study was supported by the Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) grant No. 2007/07940-8.
F. A. M. Herbella, F. P. P. Vicentine, J. C. Del Grande, and M. G. Patti have no conflicts of interest or financial ties to disclose.
- 3.Herbella FA, Patti MG (2010) Gastroesophageal reflux disease: from pathophysiology to treatment. Word J Gastroenterol 16(30):1–5Google Scholar
- 4.Herbella FA, Vicentine FP, Del Grande JC (2010) High-resolution and conventional manometry in the assessment of the lower esophageal sphincter length. J Gastrointest Surg14(9):1466-1467; author reply 1468-1469Google Scholar
- 16.Vo L, Simonian HP, Doma S, Fisher RS, Parkman HP (2005) The effect of rabeprazole on regional gastric acidity and the postprandial cardia/gastro-oesophageal junction acid layer in normal subjects: a randomized, double-blind, placebo-controlled study. Aliment Pharmacol Ther 21(11):1321–1330PubMedCrossRefGoogle Scholar
- 17.Morgan D, Pandolfino J, Katz PO, Goldstein JL, Barker PN, Illueca M (2010) Clinical trial: gastric acid suppression in Hispanic adults with symptomatic gastroesophageal reflux disease—comparator study of esomeprazole, lansoprazole, and pantoprazole. Aliment Pharmacol Ther 32(2):200–208PubMedCrossRefGoogle Scholar