Twenty-four-hour pH monitoring of esophageal function. Its use in evaluation in symptomatic patients after truncal vagotomy and gastric resection or drainage

G. C. O'Sullivan, T. R. DeMeester, R. B. Smith, J. W. Ryan, L. F. Johnson and D. B. Skinner

The incidence and character of gastrointestinal reflux after truncal vagotomy and gastric resection or drainage were studied prospectively in 42 symptomatic patients. Gastroesophageal reflux, proven by 24-hour pH monitoring, occurred in 31 patients. Initial symptoms of heartburn, regurgitation, or dysphagia were similar in patients with and without reflux. Eighteen patients had pure acid, nine had acid-alkaline, and four had pure alkaline reflux. Reflux occurred predominantly in the supine position. Esophagitis occurred only in patients with reflux and was not dependent on the pH of refluxed material. Reflux was eventually controlled by antireflux repair in 19 and by colon interposition in three patients. Twenty-four-hour esophageal pH monitoring is beneficial in evaluating symptoms after gastric surgery. It quantifies both acid and alkaline reflux, provides an objective assessment of the patient's subjective complaints, and gives a rational basis for management.