Digestive Diseases and Sciences

, Volume 63, Issue 3, pp 703–712 | Cite as

Acid Secretion and Its Relationship to Esophageal Reflux Symptom in Patients with Subtotal Gastrectomy

  • Hyun Jin Oh
  • Myung-Gyu ChoiEmail author
  • Jae Myung Park
  • Kyo Young Song
  • Han Mo Yoo
Original Article



Esophageal reflux symptom has been reported as common in patients with subtotal gastrectomy. Management of postoperative esophageal reflux symptom is not satisfactory. The aim of this study is to investigate prevalence of esophageal reflux symptom after subtotal gastrectomy and assess factors affecting esophageal reflux symptom in subtotal gastrectomy patients.


We prospectively enrolled 100 consecutive patients with subtotal gastrectomy who were regularly followed up by endoscopic examination. Acid secretory capacity was assessed by measuring messenger RNA (mRNA) expression of H+/K+-adenosine triphosphatase (ATPase) via real-time polymerase chain reaction (PCR) in biopsy specimens.


In total, 47 % of patients had typical esophageal reflux symptom, where heartburn or regurgitation was experienced at least weekly. Age, sex, body mass index, and type of reconstruction did not differ between esophageal reflux and non-esophageal-reflux groups. The esophageal reflux group had longer duration from time of operation until study (median 5.0 versus 3.6 years; P = 0.017). Hill grade for gastroesophageal (GE) flap valve was higher in the esophageal reflux group than in the non-esophageal-reflux group (P = 0.027). H+/K+-ATPase mRNA expression was higher in the esophageal reflux group than in the non-esophageal-reflux group [3967.6 (± 7583.7) versus 896.2 (± 1456.0); P = 0.006]. Multivariate analysis revealed that postoperative duration, H+/K+-ATPase mRNA expression level, and GE flap valve disruption were significantly associated with esophageal reflux symptom development.


Esophageal reflux symptom is common in patients after subtotal gastrectomy, possibly because of anti-reflux-barrier impairment and preservation of acid secretory capacity following surgery. Optimal acid suppression may be helpful in managing postoperative esophageal reflux symptom.


Gastric cancer Subtotal gastrectomy Esophageal reflux symptom H+/K+-ATPase mRNA 


Author's contribution

All authors listed were involved in the study design and interpretation of data for the work. M.G. Choi, H.J. Oh, J.M. Park, and H.M. Yoo enrolled patients and collected clinical data. M.G. Choi, H.J. Oh, J.M. Park, and K.Y. Song finished the data analysis and manuscript writing. M.G. Choi and H.J. Oh created tables and figures. M.G. Choi supervised the study. All authors approved the final version of the manuscript.


This research was supported by the Basic Science Research Program through the National Research Foundation of Korea funded by the Ministry of Education, Science, and Technology (NRF-2013R1A1A2007985) and by the program of the Global Research and Development Center through the National Research Foundation of Korea funded by the Ministry of Science, ICT, and Future Planning (NRF-2011-0031644).

Compliance with ethical standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Declaration of Helsinki of 1964 and later versions.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Hyun Jin Oh
    • 1
  • Myung-Gyu Choi
    • 2
    Email author
  • Jae Myung Park
    • 2
  • Kyo Young Song
    • 3
  • Han Mo Yoo
    • 3
  1. 1.Division of Gastroenterology, Department of Internal Medicine, Center for Cancer Prevention and DetectionNational Cancer CenterGoyang-siKorea
  2. 2.Division of Gastroenterology, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of MedicineThe Catholic University of Korea, Catholic Photomedicine Research InstituteSeoulKorea
  3. 3.Department of Surgery, College of MedicineThe Catholic University of KoreaSeoulKorea

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