Reflux and Barrett's oesophagitis after gastric surgery — long-term follow-up and implications for the roles of gastric acid and bile in oesophagitis
Article first published online: 5 MAR 2003
Alimentary Pharmacology & Therapeutics
Volume 17, Issue 4, pages 547–552, February 2003
How to Cite
Taha, A. S., Angerson, W. J. and Morran, C. G. (2003), Reflux and Barrett's oesophagitis after gastric surgery — long-term follow-up and implications for the roles of gastric acid and bile in oesophagitis. Alimentary Pharmacology & Therapeutics, 17: 547–552. doi: 10.1046/j.1365-2036.2003.01430.x
- Issue published online: 5 MAR 2003
- Article first published online: 5 MAR 2003
- Accepted for publication 7 October 2002
Background : The role of gastric acid is difficult to separate from that of bile in oesophageal reflux, and the complications of this can take many years to develop. Gastric surgery patients provide a good model for both significant bile reflux and marked gastric acid inhibition.
Aim : To study the oesophageal abnormalities in gastric surgery patients undergoing long-term follow-up, compared with patients with intact stomachs.
Methods : Two hundred and forty adult patients were endoscoped regardless of their age, sex or type of surgical procedure. Oesophageal damage was graded on a scale of 0–5, and biopsies were taken to exclude neoplasia, to diagnose Barrett's oesophagus and to identify Helicobacter pylori.
Results : Of the 240 patients studied, 140 had undergone gastric surgery 27 years (19–31 years) [median (interquartile range)] prior to endoscopy, and these patients had milder oesophageal scores and fewer cases of Barrett's oesophagitis. Of the 119 patients with post-surgical bile reflux gastritis, 31 (26%) had oesophagitis, two (1.7%) had Barrett's oesophagitis and oesophageal scores of 0 (0–1) were found. These results compared with corresponding values of 37 (37%; P = 0.11), 11 (11%; P = 0.007) and 0 (0–2) (P = 0.046), respectively, in 100 patients with intact stomachs. In addition, of the 83 patients with vagotomy, 19 had oesophagitis (23%; P = 0.05), none had Barrett's oesophagitis and lower oesophageal scores (P = 0.02) were found.
Conclusions : The prevalence and severity of reflux and Barrett's oesophagitis are not increased in patients with a long history of gastric surgery, particularly after vagotomy, and despite being at risk of bile reflux.