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

Rocha, Júlio Rafael Mariano da; Cecconello, Ivan; Ribeiro, Ulysses; Baba, Elisa Ryoka; Safatle‐Ribeiro, Adriana Vaz; Iriya, Kiyoshi; Sallum, Rubens Antônio Aissar; Sakai, Paulo; Szachnowicz, Sérgio

doi:10.1007/s11605-009-1003-7

Cited by 3 publications

(5 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Therefore, the pH was higher than that in the common theory due to intestinal juices. It has been shown that acid output inhibition is enough to prevent the development of esophagitis [37], and gastric acid is considered essential to esophagus damage [38]. The results of this study suggest that ECQ show efficacy on the development of reflux esophagitis by the inhibition of gastric secretion.…”

Section: Discussionmentioning

confidence: 68%

Protective Effect of ECQ on Rat Reflux Esophagitis Model

Jang

Han

Jeong

et al. 2012

Korean J Physiol Pharmacol

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionmentioning

confidence: 68%

Protective Effect of ECQ on Rat Reflux Esophagitis Model

Jang

Han

Jeong

et al. 2012

Korean J Physiol Pharmacol

View full text Add to dashboard Cite

show abstract

“…Thus, we cannot say with certainty that the enlarged proximal gastrectomy contributed to the reduction of esophagitis and Barrett in our patients. Other authors also found the occurrence of esophagitis and Barrett's esophagus in the esophageal stump of patients with gastric tube, since its vertical position is maintained, facilitating rapid gastric emptying, as well as duodenogastric reflux 34,35,38,39 . We conducted esophagectomy with enlarged proximal gastrectomy (gastric tube) and yearly endoscopy, as experts recommend.…”

Section: Discussion Discussion Discussion Discussionmentioning

confidence: 92%

“…Considering that in these patients, basal and stimulated acid secretion is lower than that found in normal subjects, and the right colon may be affected by the disease, reconstitution with the stomach initially appeared to be a great option. However, the follow-up of patients submitted to esophagectomy with this type of reconstitution and without the use of proton pump inhibitor (PPI) may show disastrous complications, such as Barrett's esophagus and esophageal stump cancer 25,[33][34][35] .…”

Section: Discussion Discussion Discussion Discussionmentioning

confidence: 99%

“…As a consequence, there has been found up to 20% esophagitis in the cervical esophageal stump during the first year after surgery, and approximately 70% in the seventh year, and the presence of Barrett's esophagus in the cervical stump in up to 27.7% of cases, which is more serious 26,34 . Of course, the destruction of reflux containment mechanisms (loss of inferior esophageal sphincter mechanism, cardia and pylorus), promote mixed reflux (acid and bile), extremely harmful to the esophageal mucosa 36,37 .…”

Section: Discussion Discussion Discussion Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Esophagectomy with gastroplasty in advanced megaesophagus: late results of omeprazole use

Pochini¹,

Gagliardi²,

Júnior³

et al. 2015

Rev. Col. Bras. Cir.

View full text Add to dashboard Cite

Objective: To analyze the late results of advanced Chagasic megaesophagus treatment by esophagectomy associated with the use of proton pump inhibitor (omeprazole) as for the incidence of esophagitis and Barrett's esophagus in the remaining stump. Methods : We studied patients with advanced megaesophagus undergoing esophagectomy and transmediastinal esophagogastroplasty. Patients were divided into three groups: A (20) with esophageal replacement by full stomach, without the use of omeprazole; B (20) with esophageal replacement by full stomach, with omeprazole 40 mg/day introduced after the first postoperative endoscopy and maintained for six years; and C (30) with esophageal replacement by gastric tube with use of omeprazole. Dysphagia, weight loss and BMI were clinical parameters we analyzed. Upper gastrointestinal endoscopy was performed in all patients, and determined the height of the anastomosis, the aspect of the mucosa, with special attention to possible injuries arising from gastroesophageal reflux, and the patency of the esophagogastric anastomosis. Results : We studied 50 patients, 28 males (56%) and 22 (44%) females. All underwent endoscopy every year. In the first endoscopy, erosive esophagitis was present in nine patients (18%) and Barrett's esophagus, in four (8%); in the last endoscopy, erosive esophagitis was present in five patients (8%) and Barrett's esophagus in one (2%). When comparing groups B and C, there was no evidence that the manufacturing of a gastric tube reduced esophagitis and Barrett's esophagus. However, when comparing groups A and C, omeprazole use was correlated with reduction of reflux complications such as esophagitis and Barrett's esophagus (p <0.005). Conclusion : The use of omeprazole (40 mg/day) reduced the onset of erosive esophagitis and Barrett's esophagus during the late postoperative period.

show abstract

“…Preoperative and postoperative gastric acid secretion has been identified as a potential influence on the development of post‐esophagectomy Barrett's. A single study that addressed this issue was identified . Thirty‐eight patients with end‐stage achalasia underwent presurgical and post‐surgical measurement of basal and stimulated gastric acid secretion.…”

Section: Association With Gastric Acid Secretion and Ppi Usementioning

confidence: 99%

Columnar metaplasia in the esophageal remnant after esophagectomy: a systematic review

2013

View full text Add to dashboard Cite

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.

show abstract

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

Abstract: Barrett'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.

Cited by 3 publications

References 19 publications

Protective Effect of ECQ on Rat Reflux Esophagitis Model

Protective Effect of ECQ on Rat Reflux Esophagitis Model

Esophagectomy with gastroplasty in advanced megaesophagus: late results of omeprazole use

Columnar metaplasia in the esophageal remnant after esophagectomy: a systematic review

Contact Info

Product

Resources

About