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KMID : 0359020080370040243
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Korean Journal of Gastrointestinal Endoscopy
2008 Volume.37 No. 4 p.243 ~ p.252
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Incidence and Risk Factors of Reflux Esophagitis after a Subtotal Gastrectomy
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Kang Seung-Joo
Hwang Jin-Hyeok
Jeong Sook-Hyang
Kim Na-Young
Lee Dong-Ho
Jung Hyun-Chae
Song In-Sung
Kim Jin-Wook
Lee Sang-Hyub
Park Young-Soo
Kim Mi-Na
Jo Hyun-Jin
Kim Su-Hyun
Park Jin-Myung
Choi Mun-Sun
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Abstract
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Background/Aims: The aims of this study were to evaluate the incidence of reflux esophagitis in patients after a subtotal gastrectomy and to determine risk factors for reflux esophagitis.
Methods: Among 225 patients who underwent a subtotal gastrectomy from June 2003 to December 2004 at Seoul National University Bundang Hospital, 201 patients who received follow-up for more than six months and underwent at least one endoscpoic examination were retrospectively reviewed. We used the Los Angeles (LA) classification system
and included a minimal change for reflux esophagitis.
Results: There were 173 patients who underwent a Billroth I procedure and 28 patients who underwent a Billroth II procedure. The cumulative incidence of reflux esophagitis was 40.8%. A patient age ≥65 years (p=0.04), a follow-up duration ≥40 months (p=0.03), bile reflux gastritis (p＜0.01) and postoperative obesity (p=0.02) were significant risk factors for the development of reflux esophagitis including a minimal change. The number of postoperative endoscopies ≥4 (p=0.012), bile reflux gastritis (p=0.002) and postoperative obesity (p=0.038) were risk factors for a minimal change. A patient age ≥65 years (p=0.04), a follow-up duration ≥40 months (p=0.03) and Helicobacter pylori eradication before surgery (p＜0.01) were independent risk factors for LA grade A/B reflux esophagitis.
Conclusions: Bile reflux gastritis is a risk factor for the development of reflux esophagitis after a subtotal gastrectomy. Preoperative helicobacter eradication is also associated with reflux esophagitis, except for a minimal change, but further studies are needed. (Korean J Gastrointest Endosc 2008;37:243-252)
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KEYWORD
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Reflux esophagitis, Subtotal gastrectomy, Bile reflux, Helicobacter pylori
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