Duodenogastric Reflux Potentiates the Injurious Effects of Gastroesophageal Reflux

被引：47

作者：

Fein M. ^{[1
]}

Ireland A.P. ^{[1
]}

Ritter M.P. ^{[1
]}

Peters J.H. ^{[1
]}

Hagen J.A. ^{[1
]}

Bremner C.G. ^{[1
]}

DeMeester T.R. ^{[1
,2
]}

机构：

[1] Department of Surgery, Univ. of S. California Sch. of Med., Los Angeles, CA

[2] Department of Surgery, Univ. of S. California Sch. of Med., Los Angeles, CA 90033-4612

来源：

Journal of Gastrointestinal Surgery | 1997年 / 1卷 / 1期

关键词：

Acid Exposure; Erosive Esophagitis; Esophageal Acid Exposure; Esophageal Injury; Duodenal Juice;

D O I：

10.1007/s11605-006-0006-x

中图分类号：

学科分类号：

摘要：

Experimental studies have shown that the severity of esophageal mucosal injury in gastroesophageal reflux disease is related to the reflux of both gastric and duodenal juice. The purpose of this study was to determine whether duodenal juice potentiates esophageal injury in patients with reflux disease or, in fact, causes no harm allowing acid and pepsin to do the damage. A total of 148 consecutive patients who had no previous gastric or esophageal surgery underwent endoscopy and biopsy, manometry, and 24-hour esophageal pH and bilirubin monitoring. Esophageal injury was defined by the presence of erosive esophagitis, stricture, or biopsy-proved Barrett's esophagus. Exposure to duodenal juice, identified by the absorbance of bilirubin, was defined as an exposure time exceeding the ninety-fifth percentile measured in 35 volunteers. To separate the effects of gastric and duodenal juice, patients were stratified according to their acid exposure time. One hundred patients had documented acid reflux on pH monitoring, and in 63 of them it was combined with reflux of duodenal juice. Patients with combined reflux (50 of 63) were more likely to have injury than patients without combined reflux (22 of 37; P < 0.05). When the acid exposure time was greater than 10%, patients with injury (n = 40) had a greater exposure to duodenal juice (median exposure time 17.2% vs. 1.1%, P = 0.006) than patients without injury (n = 5), but there was no difference in their acid exposure (16.9% vs. 13.4%). Patients with dysplasia of Barrett's epithelium (n = 9) had a greater exposure to duodenal juice (median exposure time 30.2% vs. 7.2%, P = 0.04) compared to patients without complications (n = 25), whereas acid exposure was the same (16.4% vs. 15%). Duodenal juice adds a noxious component to the refluxed gastric juice and potentiates the injurious effects of gastric juice on the esophageal mucosa.

引用

页码：27 / 33

页数：6

共 28 条

[1]

Brossard E., Monnier P., Fontolliet C., Krayenbuhl M., Savary M., Columnar-type epithelium (Barrett's epithelium) develops after healing in 18% of adults with erosive or ulcerative reflux esophagitis, Gastroenterology, 100, (1993)

[2]

Hameeteman W., Tytgat G.N., Houthoff H.J., Van Den Tweel J.G., Barrett's esophagus: Development of dysplasia and adenocarcinoma, Gastroenterology, 96, pp. 1249-1256, (1989)

[3]

Lillemoe K.D., Johnson L.F., Harmon J.W., Alkaline esophagitis: A comparison of the ability of components of gastroduodenal contents to injure the rabbit esophagus, Gastroenterology, 85, pp. 621-628, (1983)

[4]

Levrat M., Lambert R., Kirshbaum G., Esophagitis produced by reflux of duodenal contents in rats, Am J Dig Dis, 7, pp. 564-573, (1962)

[5]

Clark G.W., Smyrk T.C., Mirvish S.S., Anselmino M., Yamashita Y., Hinder R.A., DeMeester T.R., Birt D.F., Effect of gastroduodenal juice and dietary fat on the development of Barrett's esophagus and esophageal neoplasia: An experimental rat model, Ann Surg Oncol, 1, pp. 252-261, (1994)

[6]

Miwa K., Segawa M., Takano Y., Matsumoto H., Sahara H., Yagi M., Miyazaki I., Hattori T., Induction of oesophageal and forestomach carcinomas in rats by reflux of duodenal contents, Br J Cancer, 70, pp. 185-189, (1994)

[7]

Pera M., Cardesa A., Bombi J.A., Ernst H., Pera C., Mohr U., Influence of esophagojejunostomy on the induction of adenocarcinoma of the distal esophagus in Sprague-Dawley rats by subcutaneous injection of 2,6-dimethylnitrosomorpholine, Cancer Res, 49, pp. 6803-6808, (1989)

[8]

Attwood S.E., Smyrk T.C., DeMeester T.R., Mirvish S.S., Stein H.J., Hinder R.A., Duodenoesophageal reflux and the development of esophageal adenocarcinoma in rats, Surgery, 111, pp. 503-510, (1992)

[9]

Pera M., Trastek V.F., Carpenter H.A., Fernandez P.L., Cardesa A., Mohr U., Pairolero P.C., Influence of pancreatic and biliary reflux on the development of esophageal carcinoma, Ann Thorac Surg, 55, pp. 1386-1392, (1993)

[10]

Gillen P., Keeling P., Byrne P., Healy M., O'Moore P.R., Hennessy T.P.J., Implication of duodenogastric reflux in the pathogenesis of Barrett's oesophagus, Br J Surg, 75, pp. 540-543, (1988)

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