Duodenogastric reflux and foregut carcinogenesis

Abstract

Epidemiologic cohort studies have established that after distal gastric resection, there is a higher risk of gastric carcinoma. It is likely that a main factor of this higher risk is the excessive duodenogastric reflux induced by surgery, because the incidence of stump carcinomas is higher in Billroth II than in Billroth I, and most of the stump carcinomas are located near the stoma. In addition, several groups of investigators have suggested that duodenogastric reflux per se induces stump carcinomas in rats. There is another human duodenogastric reflux, the primary duodenogastric reflux, through the pylorus. Experiments in animals have demonstrated that this type of duodenal reflux also induces gastric carcinomas in the antrum of the stomach that has not undergone surgery. Recent clinical attention has focused on the role of duodenogastric reflux in the pathogenesis of Barrett's esophagus and subsequent esophageal adenocarcinomas. Experimentally, reflux of duodenal contents into the esophagus can cause not only Barrett's esophagus and subsequent adenocarcinomas, but also squamous cell carcinomas. These findings suggest that duodenogastric reflux may be implicated in gastric and esophageal, that is, foregut carcinogenesis. Cancer 1995;75:1426‐32.

Randomised clinical trial: the effects ofHelicobacter pylorieradication on glandular atrophy and intestinal metaplasia after subtotal gastrectomy for gastric cancer

“…17 The development of carcinoma in gastric remnants following distal gastrectomy and in the stomachs of experimental animals subjected to enterogastric reflux has also been attributed to exposure to bile and/or duodenopancreatic contents. 39 Therefore, bile refluxed into the remnant stomach may not only decrease the development of metachronous tumours by suppressing H. pylori survival but it can also strengthen carcinogenesis through another mechanism unrelated to H. pylori infection. Both Billroth I gastroduodenostomy and Billroth II gastrojejunostomy reconstruction methods allow bile reflux, but the Billroth II procedure has been reported to have a higher reflux rate than Billroth I reconstruction.…”

A selective cyclooxygenase‐2 inhibitor prevents inflammation‐related squamous cell carcinogenesis of the forestomach via duodenogastric reflux in rats

“…Chronic reflux of duodenal contents into the foregut lumen is thought to be directly linked with pathogenesis, such as some gastric lesions, Barrett esophagus, and esophageal adenocarcinoma (ADC). 1 Conversely, esophageal squamous cell carcinoma (SCC) has a multifactorial etiology involving several environmental, dietary, and other genetic factors. Although reflux symptoms are not associated as a risk for esophageal SCC, in contrast to esophageal ADC, 2 great interest has focused on chronic acid and alkaline reflux as another factor associated with an increased risk for laryngeal SCC through inflammation.…”

A clinicopathological study of gastric stump carcinoma following proximal gastrectomy

“…Refl ux of duodenal fl uid such as bile or pancreatic juice was reported to be associated with the development of gastric carcinoma after distal gastrectomy [21][22][23][24][25][26].…”