Roux-en-Y Reconstruction is Superior to Billroth I Reconstruction in Reducing Reflux Esophagitis After Distal Gastrectomy: Special Relationship with the Angle of His

The aim of the present study was to evaluate the relationship between the angle of His in Roux-en-Y (RY) or Billroth I (BI) reconstruction and reflux esophagitis after distal gastrectomy for gastric cancer. Results for 47 patients undergoing BI reconstruction and 38 patients undergoing RY reconstruction were examined retrospectively. The angle of His and the incidence of reflux esophagitis were determined, and the quality of life (QOL) was evaluated with the Gastrointestinal Symptom Rating Scale (GSRS). The angle of His was significantly greater in patients who underwent BI compared with RY reconstruction, as well as in patients with reflux esophagitis. Scores for reflux, diarrhea, and total symptoms on the GSRS were significantly better in the RY group than in the BI group. The angle of His is an important determinant of reflux esophagitis following distal gastrectomy. The decreased angle of His in patients after RY compared with BI reconstruction may contribute significantly to the reduced incidence of reflux esophagitis and improved QOL in patients who undergo RY reconstruction.