Incidence and Risk Factors of Reflux Esophagitis after a Subtotal Gastrectomy

Korean J Gastrointest Endosc > Volume 37(4); 2008 > Article

Korean Journal of Gastrointestinal Endoscopy 2008;37(4): 243-252.

부분 위 절제술을 받은 환자에서 역류성 식도염의 발생률과 위험인자

강승주ㆍ김미나ㆍ김수현ㆍ박진명ㆍ조현진ㆍ최문선ㆍ이상협*ㆍ박영수*ㆍ황진혁*ㆍ김진욱*ㆍ정숙향*ㆍ김나영*ㆍ이동호*ㆍ정현채ㆍ송인성

서울대학교 의과대학 내과학교실,*분당서울대병원 내과

Incidence and Risk Factors of Reflux Esophagitis after a Subtotal Gastrectomy

Seung Joo Kang, M.D., Mi Na Kim, M.D., Su Hyun Kim, M.D., Jin Myung Park, M.D., Hyun Jin Jo, M.D., Mun Sun Choi, M.D., Sang Hyub Lee, M.D.*, Young Soo Park, M.D.*, Jin Hyeok Hwang, M.D.*, Jin Wook Kim, M.D.*, Sook Hyang Jung, M.D.*, Nayoung Kim, M.D.*, D

Department of Internal Medicine, Seoul National University College of Medicine, Seoul, *Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea

Abstract

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)

Key Words: Reflux esophagitis, Subtotal gastrectomy, Bile reflux, Helicobacter pylori

주요어: 역류성 식도염, 부분 위 절제술, 담즙 역류, 헬리코박터