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№3' 2018
SURGERYInternational Medical Journal, Vol. 24., Iss. 3, 2018, P. 24−28.
CHANGES IN POSTPRANDIAL ACID POCKET AND ITS ROLE IN THE DEVELOPMENT OF GASTROESOPHAGEAL REFLUX IN PATIENTS WITH COMPLICATED FORMS OF PEPTIC ULCER
Kharkiv Medical Academy of Postgraduate Education, Kharkiv, Ukraine
At present, the issues of topographic−anatomical features of the postprandial acid pocket when choosing an antireflux operation has not been sufficiently investigated. The state of the postprandial acid pocket after various antireflux operations and its role in the development of pathological gastroesophageal reflux recurrence in the postoperative period also remain topical. Topographic and anatomical features of the postprandial acid pocket and its role in development of gastroesophageal reflux in patients with complicated forms of peptic ulcer disease were investigated. To diagnose gastroesophageal reflux daily multichannel esophago−pH−impedance monitoring was used. To assess the role of the postprandial acid pocket, fragments of the pH−impedance−monitoring charts reflecting the period of daily meals and the postprandial period (up to 2 hours) in patients with different levels of postprandial acid pocket location relative to the diaphragm were selected. Comparative analysis of the obtained data in patients with complicated forms of peptic ulcer disease and different location of the postprandial acid pocket showed that the most favorable conditions for development of acid gastroesophageal reflux are formed when the postprandial acid pocket is located above the diaphragm in the hernial cavity. In the postprandial period, a significant increase (p < 0,05) of the reflux time was established in patients with concomitant hiatal hernia. Thus, our investigation confirmed the existence of postprandial acid pocket and its role in acid gastroesophageal reflux in this group of patients. The total time (p < 0,05) of acid reflux in the postprandial period and their number (p > 0,05) depends on the size of the postprandial acid pocket and its position relative to the diaphragm. The risk of acid gastroesophageal reflux is higher in patients with complicated form of peptic ulcer disease and accompanying hiatal hernia.
Key words: peptic ulcer disease, hiatal hernia, postprandial acid pocket, gastroesophageal reflux.