Cases reported "Duodenogastric Reflux"

Filter by keywords:



Filtering documents. Please wait...

1/3. Development of Barrett's esophagus six months after total gastrectomy.

    Barrett's esophagus (BE) is an acquired disease of the esophagus, in which esophageal squamous epithelium is changed by injury from reflux to metaplastic intestinal type columnar epithelium. BE is the premalignant lesion of adenocarcinoma of the esophagus. It is widely accepted that the long-standing reflux of gastric acid is a catalyst for the development of BE. More recent work points toward the reflux of duodenal secretions as a catalyst in this disease process as well. Moreover, the time course for the development of BE once a patient has reflux is not known. Our case challenges the currently defined time course of "long-standing" reflux symptoms for the development of BE, and supports the role of duodenal secretions alone in the development of BE. A 68-yr-old Caucasian man was admitted with weight loss, left upper quadrant pain, a hemoglobin of 6.8, and heme-positive stool. Esophagogastroduodenoscopy (EGD) revealed normal esophageal mucosa and a mass in the gastric cardia. Biopsies showed moderately differentiated gastric adenocarcinoma. The patient underwent a total gastrectomy, distal esophagectomy, and a Roux-en-Y esophagojejunostomy. pathology confirmed gastric adenocarcinoma (T1 N0 Mx). The distal esophagus and gastroesophageal junction in the resected specimen were grossly and microscopically normal. Six months later an EGD, prompted by new complaints of regurgitation and dyspepsia, revealed distal esophageal mucosa lined by red-colored columnar tissue. Biopsies showed intestinal type epithelium. Thus, our case report's contribution to the current literature is twofold. It provides evidence of development of BE solely from duodenal reflux, and it documents a relatively short time span to development of BE.
- - - - - - - - - -
ranking = 1
keywords = esophagus
(Clic here for more details about this article)

2/3. Characteristics of distal partial gastrectomy patients with esophageal symptoms of duodenogastric reflux.

    OBJECTIVES: Partial gastrectomy patients with anatomic alterations to the pylorus and acid secretion are excellent models for studying the controversial role of duodenogastric reflux in producing esophageal symptoms and esophagitis. methods: We studied 13 partial gastrectomy patients who had recent upper gastrointestinal endoscopies and chronic duodenogastric reflux symptoms. Simultaneously, acid and duodenogastric reflux were assessed by ambulatory 24-h esophageal pH and bilirubin monitoring. Abnormal values for both acid and bilirubin reflux were defined by previous studies of healthy volunteers from our laboratory. Symptoms were recorded and correlated with acid and duodenogastric reflux episodes. RESULTS: Mean percent time bilirubin reflux for the entire group was 26.8 /- 7.2% (range 0.4-91.2%), whereas mean percent total acid reflux was 4.6 /- 2.4% (range 0.0-26.1%). Ten (77%) patients had abnormal duodenogastric reflux, but three patients (23%) also had associated abnormal acid reflux. Only these three patients had esophagitis, two ulcerative and one Barrett's esophagus. A total of 75 symptoms (36 heartburn, 33 epigastric pains, three regurgitation, two nausea/vomiting, one abdominal distension) were reported; 65% were acid related. Of patients with heartburn and regurgitation, 97% were associated with acid reflux episodes. CONCLUSIONS: Although excessive amounts of duodenogastric reflux are common in partial gastrectomy patients, esophagitis and Barrett's esophagus are seen only in patients with concomitant acid reflux, and most esophageal symptoms are acid related. Therefore, acid rather than duodenogastric reflux is the main culprit in this syndrome and should be aggressively treated.
- - - - - - - - - -
ranking = 0.25
keywords = esophagus
(Clic here for more details about this article)

3/3. Early esophageal adenocarcinoma arising in a short segment of Barrett's mucosa after total gastrectomy.

    A 66-yr-old man had undergone a total gastrectomy with esophagojejunostomy for gastric cancer 29 yr previously. Soon after the operation, he began to suffer frequent bile regurgitation and subsequent alkaline reflux esophagitis. A small esophageal tumor was found incidentally above the esophagojejunostomy at a follow-up endoscopy, and he subsequently underwent a lower esophagectomy in 1995. The resected specimen revealed evidence of an early adenocarcinoma arising in a short segment of columnar cell-lined esophagus which had not been grossly evident prior to the esophagectomy. The present case indicates that columnar metaplasia with a neoplastic potential can be induced in the esophagus by the chronic reflux of duodenal contents in the absence of gastric acid.
- - - - - - - - - -
ranking = 0.25
keywords = esophagus
(Clic here for more details about this article)


Leave a message about 'Duodenogastric Reflux'


We do not evaluate or guarantee the accuracy of any content in this site. Click here for the full disclaimer.