Should peri-gastrectomy gastric acidity be our focus among gastric cancer patients?

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

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(typeⅡorⅢ)and needed surgical management were enrolled.They all underwent gastrectomy by the same operators[35undergoing 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 preoperational 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 potassi-um,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 tumornode-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±1.31vs 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 vs9.15±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 postgastrectomy.