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The Significance of the Gastric Secretory State in Gastroesophageal Reflux Disease

The Significance of the Gastric Secretory State in Gastroesophageal Reflux Disease Abstract • The gastric secretory status of 75 patients with abnormal esophageal exposure to gastric juice proved by 24-hour pH monitoring was measured to study the significance of gastric hypersecretion in gastroesophageal reflux disease. Gastric hypersecretion was a less-frequent finding than a mechanically defective sphincter (28% vs 72%, respectively). Forty-eight percent of patients with a normal sphincter, compared with 20% of those with a defective sphincter, were hypersecretors. In the presence of normal gastric secretion, complications occurred in 18% of those with a normal sphincter and 77% of those with a defective sphincter. In the presence of hypersecretion, the complication rate was 40% and 82%, respectively. These findings show that the development of reflux complications are related to a defective sphincter. Gastric hypersecretion in reflux patients with a normal sphincter is best treated by acid reduction using H2 blockers. Patients with a mechanically defective sphincter, regardless of their gastric secretory state, should have an antireflux procedure. (Arch Surg. 1989;124:937-940) References 1. Bonavina L, Evander A, DeMeester TR, et al. Length of the distal esophageal sphincter and competency of the cardia . Am J Surg . 1986;151:25-34.Crossref 2. Malagelada JR. Physiologic basis and clinical significance of gastric emptying disorders . Dig Dis Sci . 1979;24:657-661.Crossref 3. Boesby S. Relationship between gastroesophageal reflux, basal gastroesophageal sphincter pressure and gastric acid secretion . Scand J Gastroenterol . 1977;12:547-551.Crossref 4. Little AG, DeMeester TR, Kirchner PT, O'Sullivan GC, Skinner DB. Pathogenesis of esophagitis in patients with gastroesophageal reflux . Surgery . 1980;88:101-107. 5. Bremner CG. Barrett's esophagus . In: DeMeester TR, Matthews HR, eds. International Trends in General Thoracic Surgery , III: Benign Esophageal Disease. St Louis, Mo: CV Mosby Co; 1987:227-239. 6. Winans CS, Harris LD. Quantitation of lower esophageal sphincter competence . Gastroenterology . 1967;52:773-778. 7. Zaninotto G, DeMeester TR, Schwizer W, Johansson KE, Cheng SC. The lower esophageal sphincter in health and disease . Am J Surg . 1988;155:104-111.Crossref 8. DeMeester TR, Wang CI, Wernly JA, et al. Technique, indications and clinical use of 24-hour esophageal pH monitoring . J Thorac Cardiovasc Surg . 1980;79:656-670. 9. DeMeester TR. Prolonged esophageal pH monitoring. In: Read NW, ed. Clinical Applications of Investigations of Gastrointestinal Motility. New York, NY: John Wiley & Sons Inc. In press. 10. Spiro HM. General considerations . In: Spiro HM, ed. Clinical Gastroenterology . 3rd ed. New York, NY: Macmillan Publishing Co Inc; 1983:186-206. 11. Cheli R, Bovero E. Anatomico-functional gastric aspects in duodenal ulcer . In: Porro GB, Bardhan KD, eds. Topics in Peptic Ulcer Disease . Westport, Conn: Cortina Learning International Inc; 1987:3-8. 12. Winkelstein A, Wolf BS, Som ML, Marshak RH. Peptic esophagitis with duodenal or gastric ulcer . JAMA . 1954;154:885-889.Crossref 13. Johansson KE, Ask P, Boeryd B, Fransson SG, Tibbling L. Oesophagitis, signs of reflux and gastric acid secretion in patients with gastro-oesophageal reflux disease . Scand J Gastroenterol . 1986;21:837-847.Crossref 14. Casten DF. Esophageal hiatal hernia and gastric acid secretion . Arch Surg . 1964;88:255-259.Crossref 15. Williams CB, Lawrie JH, Forrest APM. Acid secretion in symptomatic sliding hiatal hernia . Lancet . 1967;1:184-185.Crossref 16. Csendes A, Larrain A, Uribe P. Gastric acid secretion in patients with a symptomatic gastroesophageal reflux and patients with esophageal strictures . Ann Surg . 1974;179:119-122.Crossref 17. Regan PT, Malagelada J-R. A reappraisal of clinical, roentgenographic and endoscopic features of the Zollinger-Ellison Syndrome . Mayo Clin Proc . 1978;53:19-23. 18. Helm JF, Dodds WJ, Riedel DR, Teeter BC, Hogan WJ, Arndorfer RC. Determinants of esophageal acid clearance in normal subjects . Gastroenterology . 1983;85:607-612. 19. Mulholland MW, Melendez RL, Reid BJ, Levine DS, Rubin CE. Stimulated gastric acid secretion in patients with reflux esophagitis . Gastroenterology . 1988;94:A314. 20. Hetzel DJ, Dent J, Reed WD, et al. Healing and relapse of severe peptic esophagitis after treatment with omeprazole . Gastroenterology . 1988;95:903-912. 21. Skinner D, Belsey R. Surgical management of esophageal reflux and hiatus hernia: long-term results with 1030 patients . J Thorac Cardiovasc Surg . 1967;53:33-54. 22. Lieberman DA. Medical therapy for chronic reflux esophagitis: longterm follow-up . Arch Intern Med . 1987;147:1717-1720.Crossref 23. Salzman M, Barwick K, McCallum RW. Progression of cimetidinetreated reflux esophagitis to a Barrett's stricture . Dig Dis Sci . 1982;27:181-186.Crossref 24. Kothari T, Mangla JC, Kalra TMS. Barrett's ulcer and treatment with cimetidine . Arch Intern Med . 1980;140:475-477.Crossref 25. DeMeester TR, Bonavina L, Albertucci M. Nissen fundoplication for gastroesophageal reflux disease: evaluation of primary repair in 100 consecutive patients . Ann Surg . 1986;204:9-20.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Surgery American Medical Association

The Significance of the Gastric Secretory State in Gastroesophageal Reflux Disease

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Publisher
American Medical Association
Copyright
Copyright © 1989 American Medical Association. All Rights Reserved.
ISSN
0004-0010
eISSN
1538-3644
DOI
10.1001/archsurg.1989.01410080069011
Publisher site
See Article on Publisher Site

Abstract

Abstract • The gastric secretory status of 75 patients with abnormal esophageal exposure to gastric juice proved by 24-hour pH monitoring was measured to study the significance of gastric hypersecretion in gastroesophageal reflux disease. Gastric hypersecretion was a less-frequent finding than a mechanically defective sphincter (28% vs 72%, respectively). Forty-eight percent of patients with a normal sphincter, compared with 20% of those with a defective sphincter, were hypersecretors. In the presence of normal gastric secretion, complications occurred in 18% of those with a normal sphincter and 77% of those with a defective sphincter. In the presence of hypersecretion, the complication rate was 40% and 82%, respectively. These findings show that the development of reflux complications are related to a defective sphincter. Gastric hypersecretion in reflux patients with a normal sphincter is best treated by acid reduction using H2 blockers. Patients with a mechanically defective sphincter, regardless of their gastric secretory state, should have an antireflux procedure. (Arch Surg. 1989;124:937-940) References 1. Bonavina L, Evander A, DeMeester TR, et al. Length of the distal esophageal sphincter and competency of the cardia . Am J Surg . 1986;151:25-34.Crossref 2. Malagelada JR. Physiologic basis and clinical significance of gastric emptying disorders . Dig Dis Sci . 1979;24:657-661.Crossref 3. Boesby S. Relationship between gastroesophageal reflux, basal gastroesophageal sphincter pressure and gastric acid secretion . Scand J Gastroenterol . 1977;12:547-551.Crossref 4. Little AG, DeMeester TR, Kirchner PT, O'Sullivan GC, Skinner DB. Pathogenesis of esophagitis in patients with gastroesophageal reflux . Surgery . 1980;88:101-107. 5. Bremner CG. Barrett's esophagus . In: DeMeester TR, Matthews HR, eds. International Trends in General Thoracic Surgery , III: Benign Esophageal Disease. St Louis, Mo: CV Mosby Co; 1987:227-239. 6. Winans CS, Harris LD. Quantitation of lower esophageal sphincter competence . Gastroenterology . 1967;52:773-778. 7. Zaninotto G, DeMeester TR, Schwizer W, Johansson KE, Cheng SC. The lower esophageal sphincter in health and disease . Am J Surg . 1988;155:104-111.Crossref 8. DeMeester TR, Wang CI, Wernly JA, et al. Technique, indications and clinical use of 24-hour esophageal pH monitoring . J Thorac Cardiovasc Surg . 1980;79:656-670. 9. DeMeester TR. Prolonged esophageal pH monitoring. In: Read NW, ed. Clinical Applications of Investigations of Gastrointestinal Motility. New York, NY: John Wiley & Sons Inc. In press. 10. Spiro HM. General considerations . In: Spiro HM, ed. Clinical Gastroenterology . 3rd ed. New York, NY: Macmillan Publishing Co Inc; 1983:186-206. 11. Cheli R, Bovero E. Anatomico-functional gastric aspects in duodenal ulcer . In: Porro GB, Bardhan KD, eds. Topics in Peptic Ulcer Disease . Westport, Conn: Cortina Learning International Inc; 1987:3-8. 12. Winkelstein A, Wolf BS, Som ML, Marshak RH. Peptic esophagitis with duodenal or gastric ulcer . JAMA . 1954;154:885-889.Crossref 13. Johansson KE, Ask P, Boeryd B, Fransson SG, Tibbling L. Oesophagitis, signs of reflux and gastric acid secretion in patients with gastro-oesophageal reflux disease . Scand J Gastroenterol . 1986;21:837-847.Crossref 14. Casten DF. Esophageal hiatal hernia and gastric acid secretion . Arch Surg . 1964;88:255-259.Crossref 15. Williams CB, Lawrie JH, Forrest APM. Acid secretion in symptomatic sliding hiatal hernia . Lancet . 1967;1:184-185.Crossref 16. Csendes A, Larrain A, Uribe P. Gastric acid secretion in patients with a symptomatic gastroesophageal reflux and patients with esophageal strictures . Ann Surg . 1974;179:119-122.Crossref 17. Regan PT, Malagelada J-R. A reappraisal of clinical, roentgenographic and endoscopic features of the Zollinger-Ellison Syndrome . Mayo Clin Proc . 1978;53:19-23. 18. Helm JF, Dodds WJ, Riedel DR, Teeter BC, Hogan WJ, Arndorfer RC. Determinants of esophageal acid clearance in normal subjects . Gastroenterology . 1983;85:607-612. 19. Mulholland MW, Melendez RL, Reid BJ, Levine DS, Rubin CE. Stimulated gastric acid secretion in patients with reflux esophagitis . Gastroenterology . 1988;94:A314. 20. Hetzel DJ, Dent J, Reed WD, et al. Healing and relapse of severe peptic esophagitis after treatment with omeprazole . Gastroenterology . 1988;95:903-912. 21. Skinner D, Belsey R. Surgical management of esophageal reflux and hiatus hernia: long-term results with 1030 patients . J Thorac Cardiovasc Surg . 1967;53:33-54. 22. Lieberman DA. Medical therapy for chronic reflux esophagitis: longterm follow-up . Arch Intern Med . 1987;147:1717-1720.Crossref 23. Salzman M, Barwick K, McCallum RW. Progression of cimetidinetreated reflux esophagitis to a Barrett's stricture . Dig Dis Sci . 1982;27:181-186.Crossref 24. Kothari T, Mangla JC, Kalra TMS. Barrett's ulcer and treatment with cimetidine . Arch Intern Med . 1980;140:475-477.Crossref 25. DeMeester TR, Bonavina L, Albertucci M. Nissen fundoplication for gastroesophageal reflux disease: evaluation of primary repair in 100 consecutive patients . Ann Surg . 1986;204:9-20.Crossref

Journal

Archives of SurgeryAmerican Medical Association

Published: Aug 1, 1989

References

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