Intestinal Metaplasia in Patients With Columnar Lined Esophagus is Associated With High Levels of Duodenogastroesophageal Reflux

Haro, L. Martinez De; Ortiz, A. S.; Parrilla, Pascual; Munítiz, Vicente; Molina, Joaquín; Bermejo, Juan; Zambudio, A. Ríos

doi:10.1097/00000658-200101000-00006

Cited by 39 publications

(21 citation statements)

References 24 publications

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“…The upper quartile of this measurement is comparable with our results of the older group. Similar to our results for younger controls, several authors described no DGER or only low values of DGER into the esophagus for younger volunteers [4, 11, 12]. Tack et al [19] described the influence of the consistence of the meal to the results of Bilitec ® measurement in healthy subjects.…”

Section: Discussionsupporting

confidence: 88%

“…While some studies have delivered evidence that intestinal metaplasia in patients with columnar lined esophagus is associated with high levels of DGER [4,5,6], other studies found no correlation between either the presence or histological grade of carditis and gastric bilirubin exposure [7]. In the present study, bile measurements were performed with the Bilitec 2000 ® fiberoptic sensor, which detects light absorption by bilirubin.…”

Section: Introductionmentioning

confidence: 89%

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Bile Reflux into the Stomach and the Esophagus for Volunteers Older than 40 Years

Bollschweiler

Wolfgarten²,

Pütz³

et al. 2005

Digestion

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Background: An increased incidence of Barrett’s esophagus in cases with combined acidic and bile reflux is reported. The volunteers serving as controls in those studies were significantly younger than the patients. The aim of this study was to analyze bile reflux patterns of healthy volunteers aged comparably to patients with Barrett’s esophagus. Subjects and Methods: 19 older (8 f, 11 m; median age 51 years) (OV) and 20 younger (10 f, 10 m; median age 25 years) (YV) healthy volunteers without history of gastrointestinal disease or medication underwent simultaneous 24-hour pH and bile monitoring (Bilitec^®). All subjects consumed a special diet that did not interfere with bile measurements. Indicators for bile reflux in the stomach and esophagus: bilirubin probe absorption >0.25 in total measuring period (TM), upright position (excluding postprandial periods) (UP) and supine period (SP). Results: There were no differences between older and younger volunteers in pH monitoring. Comparing the periods of bilirubin exposure of the stomach, the median (lower and upper quartile) percentage of time was OV = 5.7% (1.0–15.0%) and YV = 3.5% (0.1–7.8%) respectively for TM (n.s.), OV = 3.1% (0.7–9.4%) and YV = 0.4% (0.0–7.1%) for UP (n.s.), and OV = 2.1% (0.2–16.7%) and YV = 5.9% (0.0–12.2%) respectively for SP (n.s.). In 10/19 older volunteers and in 18/20 younger volunteers, no reflux of bile into the esophagus was measured. However, 4 older volunteers presented bile reflux from 4.6 to 51% of the total measuring period in contrast to the younger group with a maximum of 1.3% of TM. Conclusion: No significant differences in bile reflux into the stomach were distinguishable between younger and older healthy volunteers, but older volunteers more frequently exhibited bile reflux into the esophagus.

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Section: Discussionsupporting

confidence: 88%

Section: Introductionmentioning

confidence: 89%

Bile Reflux into the Stomach and the Esophagus for Volunteers Older than 40 Years

Bollschweiler

Wolfgarten²,

Pütz³

et al. 2005

Digestion

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“…Some of those studies have been conducted on a mainly Caucasian and male population, whereas the present population was miscegenous and more homogenous in terms of gender. Although the etiology of Barrett's esophagus has not been completely established, possible risk factors include the frequency and duration of GERD symptoms, the presence and size of hiatal hernia, degree of lower esophageal sphincter incompetence, and alkaline or mixed gastroduodenal reflux (6,18,19,21) . Although none of these factors is related to gender, male gender is also considered to be a risk factor for Barrett's esophagus, with a proportion higher than 2:1 in most series.…”

Section: Discussionmentioning

confidence: 99%

Prevalence of Barrett's esophagus in individuals without typical symptoms of gastroesophageal reflux disease

Freitas

Moretzsohn

Coelho

2008

Arq. Gastroenterol.

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-Background -Barrett's esophagus, the major risk factor for esophageal adenocarcinoma, is detected in approximately 10%-14% of individuals submitted to upper endoscopy for the assessment of gastroesophageal reflux disease related symptoms. Prevalence studies of Barrett's esophagus in individuals without typical symptoms of gastroesophageal reflux disease have reported rates ranging from 0.6% to 25%. Aim -To determine the prevalence of Barrett's in a Brazilian population older than 50 years without typical symptoms of gastroesophageal reflux disease. Methods -A total of 104 patients (51 men), mean age of 65 years, with an indication for upper endoscopy but without symptoms of heartburn and/or acid regurgitation (determined with a validated questionnaire) were recruited. Subjects submitted to upper endoscopic examination in the last 10 years or using antisecretory medication (proton pump inhibitors) during the last 6 months were not included. Methylene blue chromoscopy was performed during the endoscopic exam to facilitate identification of the metaplastic epithelium. Results -Barrett's esophagus was diagnosed endoscopically and confirmed by histology in four patients, all of them males. The metaplastic segment was short (less than 3 cm) and free of dysplasia in all patients. The prevalence of Barrett's esophagus was 7.75% in the male population and 3.8% in the general population studied. Conclusion -Due to the low prevalence of Barrett's esophagus found in the present study, associated with the finding of short-segment Barrett's esophagus in all cases diagnosed and the absence of dysplasia in the material analyzed, endoscopic screening for Barrett's esophagus in patients above the age of 50 without the classical symptoms of gastroesophageal reflux disease is not indicated for the Brazilian population.

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“…Excision of the OGJ predisposes to reflux of duodenal contents into the oesophageal stump, and reflux symptoms adversely affect the quality of life of these patients. Furthermore, there is evidence that the duodenal contents are noxious and may, in the long term, cause mucosal changes to the oesophageal stump [8,9,10,11,12]. Reflux following proximal gastrectomy has generally been considered worse than reflux after total gastrectomy [7].…”

Section: Introductionmentioning

confidence: 99%

What Is the Difference between Proximal and Total Gastrectomy Regarding Postoperative Bile Reflux into the Oesophagus?

Katsoulis¹,

Robotis²,

Kouraklis³

et al. 2006

Dig Surg

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Background: Tumours of the oesophagogastric junction and the gastric cardia can be treated either with proximal or with total gastrectomy. Reflux of bile and other duodenal contents into the oesophagus following proximal gastrectomy has generally been considered worse than reflux after total gastrectomy. The aim of the present study was to test this assumption given that there is limited literature regarding objective evaluation of the postoperative duodeno-oesophageal reflux. Patients and Methods: We carried out bilirubin monitoring with the ambulatory spectrophotometer Bilitec 2000 in two groups of patients and in one group of healthy volunteers matched in age and sex. The proximal gastrectomy group consisted of 8 patients who underwent proximal gastrectomy and an end-to-side oesophagogastrostomy without pyloric drainage procedure. The total gastrectomy group consisted of 11 patients who underwent total gastrectomy and Roux-en-Y reconstruction with a 50-cm-long jejunal limb. The control group consisted of 8 healthy volunteers. In all cases, an absorption value of 0.14 was used as the threshold for reflux episodes. Results: The median fraction of time that bilirubin absorbance was >0.14 in the proximal versus total gastrectomy group was 47.4 and 13.4%, respectively (p = 0.02). The difference between the two groups was significant in the supine position (p = 0.03), whilst the upright position, meal and postprandial periods were not found to have significant difference. Likewise, no significant difference was found in the number of reflux episodes. The median fraction of time in the proximal gastrectomy group compared with controls was 47.4 versus 3.95% (p < 0.001), whilst in the total gastrectomy group compared with controls, itwas 13.4 versus 3.95% (p > 0.05). The number of reflux episodes in the proximal gastrectomy group compared with controls was 74 versus 21 (p = 0.02), whilst in the total gastrectomy group compared with controls, it was 103 versus 21 (p > 0.05). Conclusions: Total gastrectomy with Roux-en-Y reconstruction reduces the time of oesophageal exposure to duodenal juices as compared with proximal gastrectomy. This effect seems to be more prominent in the supine position.

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Intestinal Metaplasia in Patients With Columnar Lined Esophagus is Associated With High Levels of Duodenogastroesophageal Reflux

Cited by 39 publications

References 24 publications

Bile Reflux into the Stomach and the Esophagus for Volunteers Older than 40 Years

Bile Reflux into the Stomach and the Esophagus for Volunteers Older than 40 Years

Prevalence of Barrett's esophagus in individuals without typical symptoms of gastroesophageal reflux disease

What Is the Difference between Proximal and Total Gastrectomy Regarding Postoperative Bile Reflux into the Oesophagus?

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