Gastrointestinal pH Monitoring after Pancreatoduodenectomy

Simultaneous gastric amd intestinal pH monitorings were made three times for each patient: before pylorus preserving pancreatoduodenectomy (PPPD), during the acute phase just after PPPD, and during the chronic phase after PPPD with Billroth I -type reconstruction with reference to standard PD. In addition, the effect of H_2-receptor antagonist (famotidine) during the acute phase just after PPPD was examined. On the 3rd postoperative day after PPPD, both intragastric pH and pH3 holding time without famotidine administration were lower than before surgery. During the acute phase just after surgery, both intragastric pH and pH 3 holding time after PPPD with famotidine administration were higher than those without it (P<0.05). The residual gastric pH on the 3rd postoperative day after standard PD was not different from that before surgery. As for the chronic phase, the intragastric pH 3 holding time in the night time after PPPD was significantly lower than that before PPPD (P<0.05). There was no difference in intestinal pH between before and after PPPD. In our series, we detected only one peptic ulcer in PPPD patients (3.7%) and none in standard PD patients. This incidence is lower than that reported elsewhere. Therefore, we conclude that hyperacidity is induced after PPPD, but Billroth I-type reconstruction lowers the incidence of peptic ulcer formation.

pH monitoring

幽門輪温存

膵頭十二指腸切除