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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
  • 165 Downloads

Abstract

Background

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.

Methods

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.

Results

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.

Conclusions

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.

Keywords

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

Notes

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.

Funding

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.

References

  1. 1.
    Morii Y, Arita T, Shimoda K, et al. Jejunal interposition to prevent postgastrectomy syndromes. Br J Surg. 2000;87:1576–1579.CrossRefPubMedGoogle Scholar
  2. 2.
    Lundell L. Acid secretion and gastric surgery. Dig Dis. 2011;29:487–490.CrossRefPubMedGoogle Scholar
  3. 3.
    Im MH, Kim JW, Kim WS, et al. The impact of esophageal reflux-induced symptoms on quality of life after gastrectomy in patients with gastric cancer. J Gastric Cancer. 2014;14:15–22.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Yuasa N, Abe T, Sasaki E, Fukaya M, Nimura Y, Miyahara R. Comparison of gastroesophageal reflux in 100 patients with or without prior gastroesophageal surgery. J Gastroenterol. 2009;44:650–658.CrossRefPubMedGoogle Scholar
  5. 5.
    Kim JW, Yoon H, Kong SH, et al. Analysis of esophageal reflux after proximal gastrectomy measured by wireless ambulatory 24-hr esophageal pH monitoring and TC-99 m diisopropyliminodiacetic acid (DISIDA) scan. J Surg Oncol. 2010;101:626–633.CrossRefPubMedGoogle Scholar
  6. 6.
    Herbella FA, Vicentine FP, Del Grande JC, Patti MG, Arasaki CH. Postprandial proximal gastric acid pocket in patients after Roux-en-Y gastric bypass. J Gastrointest Surg. 2010;14:1742–1745.CrossRefPubMedGoogle Scholar
  7. 7.
    Herbella F, Vicentine F, Silva L, Patti M. Postprandial proximal gastric acid pocket in patients after distal gastrectomy. Neurogastroenterol Motil. 2011;23:1081–1083.CrossRefPubMedGoogle Scholar
  8. 8.
    Sears RJ, Champion GL, Richter JE. Characteristics of distal partial gastrectomy patients with esophageal symptoms of duodenogastric reflux. Am J Gastroenterol. 1995;90:211–215.PubMedGoogle Scholar
  9. 9.
    Wyrwich KW, Mody R, Larsen LM, Lee M, Harnam N, Revicki DA. Validation of the PAGI-SYM and PAGI-QOL among healing and maintenance of erosive esophagitis clinical trial participants. Qual Life Res. 2010;19:551–564.CrossRefPubMedGoogle Scholar
  10. 10.
    Chan Y, Ching JY, Cheung CM, et al. Development and validation of a disease-specific quality of life questionnaire for gastro-oesophageal reflux disease: the GERD-QOL questionnaire. Aliment Pharmacol Ther. 2010;31:452–460.CrossRefPubMedGoogle Scholar
  11. 11.
    Wiklund I, Carlsson J, Vakil N. Gastroesophageal reflux symptoms and well-being in a random sample of the general population of a Swedish community. Am J Gastroenterol. 2006;101:18–28.CrossRefPubMedGoogle Scholar
  12. 12.
    Vakil N, van Zanten SV, Kahrilas P, Dent J, Jones R. The Montreal definition and classification of gastroesophageal reflux disease: a global evidence-based consensus. Am J Gastroenterol. 2006;101:1900–1920. (quiz 1943).CrossRefPubMedGoogle Scholar
  13. 13.
    Lundell LR, Dent J, Bennett JR, et al. Endoscopic assessment of oesophagitis: clinical and functional correlates and further validation of the Los Angeles classification. Gut. 1999;45:172–180.CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Hill LD, Kozarek RA, Kraemer SJ, et al. The gastroesophageal flap valve: in vitro and in vivo observations. Gastrointest Endosc. 1996;44:541–547.CrossRefPubMedGoogle Scholar
  15. 15.
    Kubo M, Sasako M, Gotoda T, et al. Endoscopic evaluation of the remnant stomach after gastrectomy: proposal for a new classification. Gastric Cancer. 2002;5:83–89.CrossRefPubMedGoogle Scholar
  16. 16.
    Schmittgen TD, Livak KJ. Analyzing real-time PCR data by the comparative CT method. Nat Protoc. 2008;3:1101–1108.CrossRefPubMedGoogle Scholar
  17. 17.
    Wallmark B, Larsson H, Humble L. The relationship between gastric acid secretion and gastric H+, K+-ATPase activity. J Biol Chem. 1985;260:13681–13684.PubMedGoogle Scholar
  18. 18.
    Fujiwara Y, Nakagawa K, Kusunoki M, Tanaka T, Yamamura T, Utsunomiya J. Gastroesophageal reflux after distal gastrectomy: possible significance of the angle of His. Am J Gastroenterol. 1998;93:11–15.CrossRefPubMedGoogle Scholar
  19. 19.
    Fujiwara Y, Nakao K, Inoue T, et al. Clinical significance of hiatal hernia in the development of gastroesophageal reflux after distal gastrectomy for cancer of the stomach. J Gastroenterol Hepatol. 2006;21:1103–1107.CrossRefPubMedGoogle Scholar
  20. 20.
    Herbella F, Vicentine F, Del Grande J, Patti M. Postprandial proximal gastric acid pocket and gastric pressure in patients after gastric surgery. Neurogastroenterol Motil. 2011;23:e52–e54.CrossRefGoogle Scholar
  21. 21.
    Xiao YL, Peng S, Tao J, et al. Prevalence and symptom pattern of pathologic esophageal acid reflux in patients with functional dyspepsia based on the Rome III criteria. Am J Gastroenterol. 2010;105:2626–2631.CrossRefPubMedGoogle Scholar
  22. 22.
    Tack J, Becher A, Mulligan C, Johnson DA. Systematic review: the burden of disruptive gastro-oesophageal reflux disease on health-related quality of life. Aliment Pharmacol Ther. 2012;35:1257–1266.CrossRefPubMedGoogle Scholar
  23. 23.
    McColl KE, Clarke A, Seenan J. Acid pocket, hiatus hernia and acid reflux. Gut. 2010;59:430–431.CrossRefPubMedGoogle Scholar
  24. 24.
    Kahrilas PJ, McColl K, Fox M, et al. The acid pocket: a target for treatment in reflux disease? Am J Gastroenterol. 2013;108:1058–1064.CrossRefPubMedGoogle Scholar
  25. 25.
    Curcic J, Roy S, Schwizer A, et al. Abnormal structure and function of the esophagogastric junction and proximal stomach in gastroesophageal reflux disease. Am J Gastroenterol. 2014;109:658–667.CrossRefPubMedGoogle Scholar
  26. 26.
    Iida F, Ishizaka K, Sugenoya A. Lower esophageal sphincter pressure after subtotal gastrectomy and postoperative reflux esophagitis. Hepatogastroenterology. 1994;41:581–584.PubMedGoogle Scholar
  27. 27.
    Chang FY, Yeh CL, Lu CL, et al. Preserved esophagogastric manometric motility in patients after distal gastrectomy. Hepatogastroenterology. 1999;46:2387–2392.PubMedGoogle Scholar
  28. 28.
    Shibata Y. Effect of semifundoplication with subtotal gastrectomy for prevention of postoperative gastroesophageal reflux. J Am Coll Surg. 2004;198:212–217.CrossRefPubMedGoogle Scholar
  29. 29.
    Marcovechio Fonseca CA, Martinez JC, Piesciotto A, Yanagita ET, Denardin OV, Herani Filho B. Manometric study of the lower esophageal sphincter and esophagus in subtotal gastrectomy patients. Dis Esophagus. 2008;21:118–124.CrossRefPubMedGoogle Scholar
  30. 30.
    Soumarmon A, Lewin MJ. Gastric (H+, K+)-ATPase. Biochimie. 1986;68:1287–1291.CrossRefPubMedGoogle Scholar
  31. 31.
    Osawa H, Kita H, Ohnishi H, et al. Helicobacter pylori eradication induces marked increase in H+/K+-adenosine triphosphatase expression without altering parietal cell number in human gastric mucosa. Gut. 2006;55:152–157.CrossRefPubMedPubMedCentralGoogle Scholar
  32. 32.
    Jo HJ, Kim N, Nam RH, et al. The effect of cochinchina momordica seed extract on gastric acid secretion and morphologic change in aged rat stomach. Gut Liver. 2013;7:560–568.CrossRefPubMedPubMedCentralGoogle Scholar
  33. 33.
    Beaumont H, Bennink RJ, de Jong J, Boeckxstaens GE. The position of the acid pocket as a major risk factor for acidic reflux in healthy subjects and patients with GORD. Gut. 2010;59:441–451.CrossRefPubMedGoogle Scholar
  34. 34.
    Leibur M, Kengsepp AT, Sibul U, Truve R. Effect of proximal gastric vagotomy on the activity of hydrogen, potassium-stimulated ATPase in the gastric mucosa of patients with duodenal ulcer. Eur J Surg. 1992;158:223–226.PubMedGoogle Scholar
  35. 35.
    Joffe SN, Crocket A, Doyle D. Morphologic and functional evidence of reinnervation of the gastric parietal cell mass after parietal cell vagotomy. Am J Surg. 1982;143:80–85.CrossRefPubMedGoogle Scholar
  36. 36.
    Johnston D, Wilkinson AR, Humphrey CS, et al. Serial studies of gastric secretion in patients after highly selective (parietal cell) vagotomy without a drainage procedure for duodenal ulcer. I. Effect of highly selective vagotomy on basal and pentagastrin-stimulated maximal acid output. Gastroenterology. 1973;64:1–11.PubMedGoogle Scholar

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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