Clinical Trials Study
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World J Gastroenterol. Jun 14, 2014; 20(22): 6981-6988
Published online Jun 14, 2014. doi: 10.3748/wjg.v20.i22.6981
Should peri-gastrectomy gastric acidity be our focus among gastric cancer patients?
Lei Huang, A-Man Xu, Tuan-Jie Li, Wen-Xiu Han, Jing Xu
Lei Huang, A-Man Xu, Wen-Xiu Han, Jing Xu, Department of General Surgery, the First Affiliated Hospital of Anhui Medical University, Hefei 230022, Anhui Province, China
Tuan-Jie Li, Department of General Surgery, NanFang Hospital of Southern Medical University, Guangzhou 510515, Guangdong Province, China
Author contributions: Huang L, Xu AM, Li TJ, Han WX and Xu J designed the research; Huang L, Li TJ and Xu J performed the research; Han WX and Xu J contributed analytic tools; Huang L and Li TJ analyzed the data; Huang L and Xu AM wrote the paper.
Supported by National Natural Science Foundation of China, No. 81172036; Foundation of Anhui Science and Technology Agency, No. 12070403061
Correspondence to: A-Man Xu, MD, Professor, Chief Physician, Department of General Surgery, the First Affiliated Hospital of Anhui Medical University, No. 218, Jixi Road, Hefei 230022, Anhui Province, China. hlzt1991@sina.com
Telephone: +86-551-65334247 Fax: +86-551-63633742
Received: November 8, 2013
Revised: February 19, 2014
Accepted: March 19, 2014
Published online: June 14, 2014
Abstract

AIM: To investigate the necessity and correctness of acid suppression pre- and post-gastrectomy among gastric carcinoma (GC) patients.

METHODS: From June 2011 to April 2013, 99 patients who were diagnosed with GC or adenocarcinoma of the gastroesophageal junction (type II or III) and needed surgical management were enrolled. They all underwent gastrectomy by the same operators [35 undergoing total gastrectomy (TG) plus Roux-en-Y reconstruction, 34 distal gastrectomy (DG) plus Billroth I reconstruction, and 30 proximal gastrectomy (PG) plus gastroesophagostomy]. We collected and analyzed their gastrointestinal juice and tissues from the pre-operational day to the 5th day post-operation, and 6 mo post-surgery. Gastric pH was detected with a precise acidity meter. Gastric juice contents including potassium, sodium and bicarbonate ions, urea nitrogen, direct and indirect bilirubin, and bile acid were detected using Automatic Biochemical Analyzer. Data regarding tumor size, histological type, tumor penetration and tumor-node-metastasis (TNM) stage were obtained from the pathological records. Reflux symptoms pre- and 6 mo post-gastrectomy were evaluated by reflux disease questionnaire (RDQ) and gastroesophageal reflux disease questionnaire (GERD-Q). SPSS 16.0 was applied to analyze the data.

RESULTS: Before surgery, gastric pH was higher than the threshold of hypoacidity (4.25 ± 1.45 vs 3.5, P = 0.000), and significantly affected by age, tumor size and differentiation grade, and potassium and bicarbonate ions; advanced malignancies were accompanied with higher pH compared with early ones (4.49 ± 1.31 vs 3.66 ± 1.61, P = 0.008). After operation, gastric pH in all groups was of weak-acidity and significantly higher than that pre-gastrectomy; on days 3-5, comparisons of gastric pH were similar between the 3 groups. Six months later, gastric pH was comparable to that on days 3-5; older patients were accompanied with higher total bilirubin level, indicating more serious reflux (r = 0.238, P = 0.018); the TG and PG groups had higher RDQ (TG vs DG: 15.80 ± 5.06 vs 12.26 ± 2.14, P = 0.000; PG vs DG: 15.37 ± 3.49 vs 12.26 ± 2.14, P = 0.000) and GERD-Q scores (TG vs DG: 10.54 ± 3.16 vs 9.15 ± 2.27, P = 0.039; PG vs DG: 11.00 ± 2.07 vs 9.15 ± 2.27, P = 0.001) compared with the DG group; all gastric juice contents except potassium ion significantly rose; reflux symptom was significantly associated with patient’s body mass index, direct and indirect bilirubin, and total bile acid, while pH played no role.

CONCLUSION: Acidity is not an important factor causing unfitness among GC patients. There is no need to further alkalify gastrointestinal juice both pre- and post-gastrectomy.

Keywords: Gastric carcinoma, Gastrectomy, Reflux, Acidity, Gastrointestinal juice

Core tip: Necessity of peri-gastrectomy acid suppression for gastric cancer patients remains controversial. This innovative prospective study showed: before surgery, gastric pH was higher than the threshold of hypoacidity, and affected by age, tumor size and differentiation grade, and potassium and bicarbonate ions; advanced malignancies were accompanied with higher pH; after operation, gastric pH in all groups was of weak-acidity and higher than that pre-gastrectomy; six months later, gastric pH was comparable to that on days 3-5; reflux symptom was significantly associated with patient’s body mass index, direct and indirect bilirubin, and total bile acid, while pH played no role.