Preoperative Gastric Acid Secretion and the Risk to Develop Barrett’s Esophagus After Esophagectomy for Chagasic Achalasia

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Journal of Gastrointestinal Surgery (Impact Factor: 2.8). 11/2009; 13(11):1893-1899. DOI: 10.1007/s11605-009-1003-7


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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