Hiroto Ishizuka

Administration of a histamine2-receptor antagonist in reflux esophagitis after gastrectomy : Simultaneous pH monitoring of the esophagus and residual stomach

Abstract Some patients with protease inhibitor-resistant reflux esophagitis after distal or proximal gastrectomy may need an acid secretion inhibitor. Clinicians, however, often hesitate to administer histamine 2 -receptor antagonists (H 2 RAs) in reflux esophagitis after distal or proximal gastrectomy. If H 2 RAs raise intraesophageal pH values in alkaline exposure cases, reflux esophagitis after gastrectomy will probably worsen. In the present study, 14 patients underwent simultaneous gastroesophageal pH monitoring to investigate the pathogenesis of reflux esophagitis after gastrectomy and the effect of H 2 RA administration in alkaline exposure cases. One patient had a previous proximal gastrectomy and complained of acid reflux. Twelve (92.3%) of the 13 patients with reflux esophagitis after distal gastrectomy were considered alkaline exposure cases without acid reflux, but there was one patient in whom acid reflux was seen. Continuation of the esophageal alkaline exposure after acidification of the residual stomach was seen in alkaline exposure cases. Oral administration of cimetidine 400 mg twice (800 mg total) increased the pH of the residual stomach but did not affect the pH of the esophagus in patients with alkaline exposure. The study suggests that administration of an H 2 RA in alkaline exposure cases may not worsen esophagitis and is not contraindicated for reflux esophagitis after distal gastrectomy.