A team from Brussels, Belgium, and Cologne, Germany, determined whether the denervated stomach as an esophageal substitute recovers normal intraluminal acidity with time.
167 patients with transthoracic elevation of the stomach as esophageal replacement were included in the study.
One to 195 months after the procedure, 24-hour intraluminal gastric pH and bile were monitored in 91 and 76 patients, respectively.
9 patients underwent a second gastric pH monitoring 3 years after surgery.
The percentage of time that the gastric pH was less than 2, and bile absorbance exceeded 0.25, were calculated in reference to values from 25 healthy volunteers.
89 upper gastrointestinal endoscopies were performed in 83 patients.
Patients were divided into three groups, depending on length of follow-up: Group 1: less than 1 year; Group 2: 1 to 3 years; Group 3: more than 3 years.
The team found that the prevalence of a normal gastric pH profile was 32% in Group 1, 82% in Group 2, and 98% in Group 3.
The percentage of time that the gastric pH was less than 2 increased from Group 1 (27%) to Group 2 (56%) and Group 3 (71%), parallel to an increase in the prevalence of cervical heartburn and esophagitis.
|Prevalence of normal gastric pH profile after vagotomy:|
Less than 1 year: 32%
1 to 3 years : 82%
More than 3 years: 98%
In addition, the percentage of time that the gastric pH was less than 2 increased from 29% to 81% in the 9 patients investigated twice.
Exposure of the gastric mucosa to bile was 13% in patients with a high gastric pH profile, versus 19% in those with normal acidity.
In the esophageal remnant in 6 patients, Barrett's metaplasia developed, intestinal (n = 2) or gastric (n = 4) in type.
Dr Christian Gutschow, of the University of Louvain, Brussels, said on behalf of he group, "Early after vagotomy, intraluminal gastric acidity is reduced in two-thirds of patients. However the stomach recovers a normal intraluminal pH profile with time, so that in more than one-third of patients, disabling cervical heartburn and esophagitis develop."
"The potential for the development of Barrett's metaplasia in the esophageal remnant brings into question the use of the stomach as an esophageal substitute in benign and early neoplastic disease," he concluded.