Postprandial Proximal Gastric Acid Pocket in Patients after Roux-En-Y Gastric Bypass
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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 operations that control GERD, such as Roux-en-Y gastric bypass (RYGB) and Nissen fundoplication, change the PPGAP.
This study aims to analyze the presence of PPGAP in patients submitted to RYGB.
Fifteen patients who had a RYGB for morbid obesity (mean age 53 years, 14 females, mean time from operation 3 years) were studied. All patients were free of foregut symptoms. Patients underwent a high-resolution manometry to identify the location of the lower border of the lower esophageal sphincter (LBLES). A 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 (40 g of chocolate, 50% fat).
Acidity was not detected in the stomach of four patients before meal. After meal, PPGAP was not found in eight patients. In three patients, a PPGAP was noted with an extension of 1 to 3 cm.
PPGAP is present in a minority of patients after RYGB; this finding may explain part of the GERD control after RYGB and that the gastric fundus may play a role in the genesis of the PPGAP.
KeywordsGastroesophageal reflux Roux-en-Y gastric bypass Acid pocket
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