Preoperative Gastric Acid Secretion and the Risk to Develop Barrett’s Esophagus After Esophagectomy for Chagasic Achalasia
ABSTRACT IntroductionThe aim of this study was to determine the contribution of preoperative gastric secretory and hormonal response, to the appearance
of Barrett’s esophagus in the esophageal stump following subtotal esophagectomy.
MethodsThirty-eight end-stage chagasic achalasia patients submitted to esophagectomy and cervical gastric pull-up were followed prospectively
for a mean of 13.6 ± 9.2years. Gastric acid secretion, pepsinogen, and gastrin were measured preoperatively in 14 patients
who have developed Barrett’s esophagus (Group I), and the results were compared to 24 patients who did not develop Barrett’s
esophagus (Group II).
ResultsIn the group (I), the mean basal and stimulated preoperative gastric acid secretion was significantly higher than in the group
II (basal: 1.52 vs. 1.01, p = 0.04; stimulated: 20.83 vs. 12.60, p = 0.01). Basal and stimulated preoperative pepsinogen were also increased at the Group I compared to Group II (Basal = 139.3
vs. 101.7, p = 0.02; stimulated = 186.0 vs. 156.5, p = 0.07. There was no difference in preoperative gastrin between the two groups. Gastritis was present during endoscopy in
57.1% of the Group I, while it was detected in 16.6% of the Group II, p = 0.014.
ConclusionsBarrett’s esophagus in the esophageal stump was associated to high preoperative levels of gastric acid secretion, serum pepsinogen,
and also gastritis in the transposed stomach.
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ABSTRACT: Gastric interposition is usually considered the reconstruction of choice following esophageal resection. However, a number of reports show that esophagectomy followed by a gastric transplant is associated with poor quality of life and significant reflux esophagitis in the esophageal remnant. The aim of this work is to review the factors affecting the mucosa of the esophageal remnant when using the stomach. A Medline was conducted. Additional references and search pathways were sourced from the references of reviewed articles. Reflux disease is considered an unavoidable consequence of esophageal resection followed by gastric interposition. Mucosal damage from acid and bile exposure in the esophageal remnant affects approximatively 50% of these patients. There is usually no correlation between symptoms and the presence of mucosal damage in the remaining esophagus. Endoscopy and endoscopic biopsies are the only reliable methods to document the status of the mucosa. When present, reflux esophagitis shows a progression from inflammation to erosions and to the development of columnar lined metaplasia. Esophageal and gastric function, gastric drainage operation, level of the anastomosis, route of reconstruction, and patients' position after the operation have all been shown to influence the severity and extent of damage in the esophageal remnant. Prevention and treatment of esophagitis in the remaining esophagus are discussed. When the stomach is used as a substitute to reconstruct the esophagus whether for malignant or benign conditions, an in vivo model of reflux diseases is created. Studies using this model may help clarify molecular and cellular events that lead to irreversible insult on the esophageal mucosa. Improvement to the reconstruction itself must be sought to favor better results with the gastric transplant.Diseases of the Esophagus 07/2008; 21(5):377-88. · 1.64 Impact Factor
- JAMA The Journal of the American Medical Association 10/1989; 262(11):1433. · 29.98 Impact Factor
- Clinica Chimica Acta 01/1979; 90(2):163-9. · 2.85 Impact Factor