gastric acid pocket in patients after laparoscopic Nissen fundoplication.

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Surg Endosc. 2011 Apr 13. [Epub ahead of print]

Postprandial proximal gastric acid pocket in patients after laparoscopic Nissen

fundoplication.

Herbella FA, Vicentine FP, Del Grande JC, Patti MG.

Source

Department of Surgery, Escola ista de Medicina, Federal University of São

o, São o, Brazil, herbella.dcir@....

Abstract

BACKGROUND:

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 change in the PPGAP

may contribute to GERD control. This study aims to analyze the presence

of PPGAP in patients submitted to Nissen fundoplication.

METHODS:

Fifteen patients who had a laparoscopic Nissen fundoplication (mean

age = 61 years, 13 females, mean time from operation 1 year) were

studied. All patients were free of foregut symptoms. Patients underwent

high-resolution manometry to identify the location of the lower border

of the lower esophageal sphincter (LBLES).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.

RESULTS:

Four patterns of gastric acidity

were found: (1) acid was not detected in the studied area of the stomach in 8

(53%) patients; (2) constant acidity (stomach is not alkalinized

after meal), i.e., a buffered layer was not found in 3 (20%) patients;

(3) PPGAP was not detected, i.e., the whole stomach is alkalinized, in 1 (7%)

patient; and (4) PPGAP was noted in 3 (20%) patients with

extensions of 2, 2, and 5 cm.

CONCLUSION:

PPGAP is

present in a minority of patients after Nissen fundoplication. This

finding may explain part of the GERD control and that the gastric fundus may

play a role in the genesis of the PPGAP.

PMID:

21487860

[PubMed - as supplied by publisher]