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Postprandial Proximal Gastric Acid Pocket in Patients after Roux-En-Y Gastric Bypass

  • 2010 SSAT Poster Presentation
  • Published:
Journal of Gastrointestinal Surgery Aims and scope

Abstract

Introduction

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.

Aims

This study aims to analyze the presence of PPGAP in patients submitted to RYGB.

Methods

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).

Results

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.

Conclusion

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.

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Authors and Affiliations

  1. Department of Surgery, Escola Paulista de Medicina, Federal University of São Paulo, São Paulo, Brazil

    Fernando A. M. Herbella, Fernando P. P. Vicentine, Jose C. Del Grande & Carlos H. Arasaki

  2. Department of Surgery, University of Chicago, Chicago, IL, USA

    Marco G. Patti

  3. Surgical Gastroenterology, Division of Esophagus and Stomach, Hospital São Paulo, Rua Diogo de Faria 1087 cj 301, São Paulo, SP, Brazil, 04037-003

    Fernando A. M. Herbella

Authors
  1. Fernando A. M. Herbella
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  2. Fernando P. P. Vicentine
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  3. Jose C. Del Grande
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  4. Marco G. Patti
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  5. Carlos H. Arasaki
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Corresponding author

Correspondence to Fernando A. M. Herbella.

Additional information

Grant support

The study was supported by the Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) grant # 2007/07940-8.

Meeting presentation

Poster presentation, Digestive Disease Week (DDW), May 1–5, 2010, New Orleans, USA

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Herbella, F.A.M., Vicentine, F.P.P., Del Grande, J.C. et al. Postprandial Proximal Gastric Acid Pocket in Patients after Roux-En-Y Gastric Bypass. J Gastrointest Surg 14, 1742–1745 (2010). https://doi.org/10.1007/s11605-010-1309-5

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  • DOI: https://doi.org/10.1007/s11605-010-1309-5

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