A. Ambrosio

Role of Combined Esophagogastric Twenty-Four-Hour pH-Monitoring in the Study of Reflux Esophagitis and Alkaline Gastropathy

Twenty-four-hour esophageal pH-monitoring, which was introduced for the first time by Johnson and DeMeester in 1974 [15], has proved to be the most sensible method for the study of acid gastroesophageal reflux. The numerous investigations made in this area, the improved knowledge of esophagogastric and duodenal physiopathology [24], and the follow-up of patients who underwent gastric surgery have demonstrated that distal esophagus and stomach inflammatory damage can also be determined by “nonacid” compounds of the reflux (bile salts, lysolecitin, trypsin) [1,16, 27]. The effect of pancreatic and biliary secretion injuries on esophageal mucosa is well known [26]. In 1951 Lanzara [17] introduced the concept of “tryptic esophagitis,” i.e., “nonacid esophagitis,” in patients who underwent total gastrectomy and esophagojejunostomy. In Billroth I and Billroth II gastrectomy patients dyspeptic syndrome is well known as well as alkaline atrophic gastritis, which causes symptoms such as epigastric pain, nausea, bile vomiting, and loss of weight. These patients can often develop serious esophagitis.

A Modified Roux-en-Y End-To-End Gastrojejunostomy in the Treatment of Postoperative Alkaline Reflux: Preliminary Results

Duodenogastric reflux (DGR) and gastroesophageal reflux (GER) are physiologic events, as both appear in normal subjects during the interdigestive period. Gastric interdigestive alkalinization of normal subjects reaches 2.76%±2.0% in our experience.