Functional evaluation of the intrathoracic stomach as an oesophageal substitute

L. Bonavina, M. Anselmino, A. Ruol, R. Bardini, N. Borsato, A. Peracchia

Research output: Contribution to journalArticle

Abstract

A study of duodenogastric reflux and gastric function was undertaken in 16 patients 1-7 years after oesophagectomy and high intrathoracic oesophagogastrostomy for oesophageal carcinoma. All were able to eat satisfactorily; ten complained of mild foregut symptoms and ten had endoscopic mucosal lesions. Biliary excretion scintigraphy demonstrated pathological duodenogastric reflux in 11 patients. The emptying of a semisolid radiolabelled meal from the intrathoracic stomach in the upright position was significantly quicker than in control subjects (P <0.01). No gastric motor activity was recorded on manometry, suggesting that the transposed stomach acts like an inert tube. Results of 24-h pH monitoring showed that the area under the curve at pH <4 in the stomach was significantly less than in control subjects (P <0.001). In addition, patients had a significantly greater oesophageal alkaline exposure (P <0.001). The vagotomized intrathoracic stomach therefore empties well in the upright position, but is subjected to reflux of alkaline duodenal contents and can retain the ability to produce acid. The interaction between alkaline and acid contents in the pathogenesis of symptoms and mucosal lesions needs further investigation.

Original languageEnglish
Pages (from-to)529-532
Number of pages4
JournalBritish Journal of Surgery
Volume79
Issue number6
DOIs
Publication statusPublished - 1992

ASJC Scopus subject areas

  • Surgery

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