Acid Reflux Test for Gastroesophageal Reflux After Distal Gastrectomy: Diagnosis and Clinical Effect of Cisapride

Gastroesophageal reflux (GER) and reflux esophagitis (RE) are common complications after gastrectomy. Reflux of the gastroduodenal contents into the esophagus elicits the same set of symptoms: heartburn, regurgitation, and anterior chest pain. It has been recognized that not all patients with RE have symptoms of reflux and not all patients with reflux symptoms have RE. 1-3 The diagnostic modalities used to evaluate GER include barium study, 4 endoscopy, 5 ambulatory pH monitoring, 6 and acid perfusion, 7 acid reflux, 8 and acid clearance 9 testing. After gastrectomy, however, the postoperative gastric pH is closer to the esophageal or intestinal pH because gastric secretion is decreased. Also, some patients with some reflux symptoms may not be diagnosed by endoscopic examination because no mucosal changes are observed in the esophagus. Diagnostic testing is necessary to determine whether GER is present in a patient who underwent gastrectomy. In this study we compared the acid reflux test with the acid clearance test, barium esophagram, and endoscopy for diagnosis of GER and RE in patients after gastrectomy and to select patients for medical therapy. METHODS Patients. This study included 46 consecutive patients who had undergone Billroth I reconstruction (16 men and 10 women, aged 38‐71 years) or Billroth II reconstruction (15 men and 5 women, aged 39‐74 years) after partial gastrectomy with lymph node resection and truncal vagotomy for gastric cancer. All patients provided informed consent. They all had been outpatients for longer than 4 months (postoperative average, 15 months). Patients showing any evidence of cancer recurrence or stenosis of anastomosis were not included in this study. All patients had undergone preoperative 24-hour esophageal