Duodeno-gastro-esophageal reflux after gastric surgery: Surgical therapy and outcome in 42 consecutive patients

Luigi Bonavina, Raffaello Incarbone, Andrea Segalin, Barbara Chella, Alberto Peracchia

Research output: Contribution to journalArticle

Abstract

BACKGROUND/AIMS: Duodeno-gastro-esophageal reflux is a common event after gastric surgery and can result in severe symptoms and mucosal injury. Medical therapy is largely ineffective. The most common remedial operation consists of a long isoperistaltic Roux-en-Y limb in order to shunt duodenal contents away from the gastric pouch and the esophagus. METHODOLOGY: Between 1980 and 1996, 42 patients underwent duodenal diversion after gastric surgery. The presence of severe symptoms and/or endoscopic esophagitis unresponsive to medical therapy was considered an indication for surgery. Functional studies were performed in selected patients in an attempt to objectively document the presence of excessive duodeno-gastro-esophageal reflux. A 40-60 cm Roux-en-Y limb was constructed in all patients. RESULTS: There was no post-operative mortality. The median follow-up was 28 months (range: 5-114). Symptoms related to delayed gastric emptying persisted in 5 patients (11.9%). Overall, 32 patients (76%) had a Visick I-II score. Best results (90%) were achieved in patients with previous total gastrectomy. CONCLUSIONS: Roux-en-Y duodenal diversion should be reserved for patients with intractable symptoms and documented reflux, and is mostly effective after total gastrectomy. Patients with a residual stomach are less likely to benefit from the procedure, probably because an underlying motor disorder plays a major role in the pathogenesis of the symptoms than does the reflux of duodenal contents.

Original languageEnglish
Pages (from-to)92-96
Number of pages5
JournalHepato-Gastroenterology
Volume46
Issue number25
Publication statusPublished - 1999

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Keywords

  • Alkaline esophagitis
  • Duodenal diversion
  • Duodenogastric reflux
  • Post-gastrectomy disorders
  • Reflux gastritis

ASJC Scopus subject areas

  • Gastroenterology

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