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: This study was designed to determine the protective effect of Rumex Aquaticus Herba extracts containing quercetin-3-β-D-glucuronopyranoside (ECQ) on experimental reflux esophagitis. Reflux esophagitis was induced by surgical procedure. The rats were divided into seven groups, namely normal group, control group, ECQ (1, 3, 10, 30 mg/kg) group and omeprazole (30 mg/kg) group. ECQ and omeprazole groups received intraduodenal administration. The Rats were starved for 24 hours before the experiments, but were freely allowed to drink water. ECQ group attenuated the gross esophagitis significantly compared to that treated with omeprazole in a dose-dependent manner. ECQ decreased the volume of gastric juice and increased the gastric pH, which are similar to those of omeprazole group. In addition, ECQ inhibited the acid output effectively in reflux esophagitis. Significantly increased amounts of malondialdehyde (MDA), myeloperoxidase (MPO) activity and the mucosal depletion of reduced glutathione (GSH) were observed in the reflux esophagitis. ECQ administration attenuated the decrement of the GSH levels and affected the MDA levels and MPO activity. These results suggest that the ECQ has a protective effect which may be attributed to its multiple effects including anti-secretory, anti-oxidative and anti-inflammatory actions on reflux esophagitis in rats.Korean Journal of Physiology and Pharmacology 12/2012; 16(6):455-62. DOI:10.4196/kjpp.2012.16.6.455 · 1.26 Impact Factor
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ABSTRACT: Barrett's metaplasia is a well-recognized risk factor for esophageal adenocarcinoma. It is believed to develop in response to the injurious effects of gastroesophageal reflux. Following subtotal esophagectomy and reconstruction with a gastric conduit, many patients experience profound reflux into the remnant esophagus. Barrett's-like epithelium has been described in these patients, and they have been identified as a potential human model in which to study the early events in the development of metaplasia. This phenomenon also raises clinical concerns about the long-term fate of the esophageal remnant following surgery and the potential for further malignant change. This systematic review summarizes the literature on the prevalence and timing of Barrett's metaplasia occurring after esophagectomy, reviews the evidence regarding risk factors and malignant progression in such patients, and considers the implications for clinical practice.Diseases of the Esophagus 11/2013; 28(1). DOI:10.1111/dote.12129 · 2.06 Impact Factor