Double reflux required for severe post-op reflux esophagitis
MedWire News: Japanese researchers have shed light on the impact of acid and bile reflux, and Helicobacter pylori infection on the development of reflux esophagitis (RE) in patients who undergo esophageal resection.
"One month after esophagogastrostomy, bile reflux can be a risk factor for RE irrespective of the presence of H. pylori infection, whereas acid reflux can be a risk factor only in patients without H. pylori infection," report Toshiaki Tanaka and co-workers, from Kurume University in Fukuoka.
Noting the impact of RE and Barrett's esophagus on the quality of life in long-term esophageal cancer survivors, the team investigated the role of known risk factors for RE further in 60 patients who underwent cervical esophagogastrostomy following esophagectomy.
One month after surgery, the patients were examined for H. pylori infection, and underwent endoscopy, bilirubin monitoring, and 24-hour continuous pH monitoring.
At this time, 63% of patients were positive for H. pylori, and 27% of patients had mild RE and 5% of patients had severe RE.
Patients with RE had significantly longer periods of time when both acid and bile reflux were present in the esophagus than patients without RE. Patients with mild RE had a significantly shorter time duration of an acid pH below 4 than those with severe RE.
Patients without RE had a significantly shorter time when light absorbance by bilirubin was >0.14 than those with mild RE.
Overall, 52% of patients had acid and/or bile reflux, with 10% experiencing only acid reflux, 25% only bile reflux, and 17% both types. Of note, severe RE was present only in patients with mixed reflux.
Analysis revealed that the risk for RE was significantly increased by the absence of H. pylori, and the presence of acid and bile reflux.
There was significant correlation between bile reflux and RE regardless of H. pylori infection status, whereas acid reflux and RE were only significantly associated in patients without H. pylori infection.
Writing in the journal Diseases of the Esophagus, the team suggests that "acid-and-bile reflux might be essential for the development of severe RE."
Tanaka et al conclude: "Patients at 1 month after esophagectomy are in a specialized status that there still remains motility disorder of the digestive tracts because of truncal vagotomy.
"Further studies are warranted to clarify the mechanism by which RE develops in the remnant esophagus after esophagectomy."
By Lynda Williams