Occurrence of peptic ulcer in the gastric tube used for esophageal replacement in adults

Uchida, Yuzo; Tomonari, Kazuhide; Murakami, Shinichi; Hadama, Tetsuo; Shibata, Okihiko; Shirabe, Joji

doi:10.1007/bf02470598

Cited by 33 publications

(28 citation statements)

References 6 publications

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“…6) This condition reportedly allows bacterial proliferation and leads to enhancement of mucosal injury. 7,8) By contrast, the present case appeared to show conditions of both ischemic ulcer and enhanced gastric acid secretion, and the gastric tube ulcer was resistant to oral administration of both omeprazole and lansoprazole. We, therefore, performed H. pylori eradication therapy, since this bacterium plays an important role in the pathogenesis of gastric ulcer.…”

Section: Discussioncontrasting

confidence: 69%

Refractory Ulcer of Reconstructed Gastric Tube after Esophagectomy: A Case Report

Okamura

Takeno

Takahashi

et al. 2013

ATCS

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We report a case in which rabeprazole cured gastric tube ulcer after esophagectomy for esophageal squamous cell carcinoma (ESCC). A 47-year-old Japanese man was referred to our hospital with refractory ulcer of the reconstructed gastric tube one year after esophagectomy for ESCC. The ulcer proved refractory to healing by the administration of omeprazole or lansoprazole, or eradication of Helicobacter pylori after examinations concerning ischemia, acid over-secretion and H. pylori infection. Finally, metabolizer type was examined for proton pump inhibitors (PPIs), revealing the patient as a hetero-extensive metabolizer for the CYP2C19 genotype. This suggested sensitivity to rabeprazole, but resistance to omeprazole and lansoprazole. The refractory ulcer was subsequently cured after changing the PPI to rabeprazole. Examination of PPI metabolizer type might thus be important, along with an investigation of ischemia, acid secretion and H. pylori infection in the treatment of refractory gastric tube ulcer after esophagectomy.

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Section: Discussioncontrasting

confidence: 69%

Refractory Ulcer of Reconstructed Gastric Tube after Esophagectomy: A Case Report

Okamura

Takeno

Takahashi

et al. 2013

ATCS

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“…Uchida reported an incidence rate of 2.6% [2]. A prospective follow-up study using endoscopy in patients who underwent gastric tube reconstruction after esophageal cancer surgery indicated that 7 out of 114 patients (6.1%) had gastric ulcers [4].…”

Section: Discussionmentioning

confidence: 99%

“…The development of peptic ulcers in the gastric tube used for esophageal replacement in patients with esophageal cancer was previously considered a rare complication [1,2]. However, an increasing number of gastric tube ulcers have been reported recently [3].…”

Section: Introductionmentioning

confidence: 99%

Gastropericardial fistula resulting from ulcerative perforation of the reconstructed gastric tube after surgery for esophageal cancer

et al. 2011

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Gastropericardial fistulae are rare and may cause fatal complications such as acute purulent carditis and cardiac tamponade. The present report describes a case of a gastropericardial fistula caused by a peptic ulcer perforating a retrosternal reconstructed gastric tube 2 years after subtotal esophagectomy for esophageal cancer. Surgical intervention involved left thoracotomy, pericardium fenestration, and drainage of the pericardium and left thoracic cavity. The patient suffered postoperative complications including septic shock, acute respiratory distress syndrome, and cardiac insufficiency; however, he recovered after successful surgical intervention. In this case, the withdrawal of proton pump inhibitors and the patient's sustained drinking habit after esophageal replacement surgery may have caused peptic ulcers in the gastric tube. Early diagnosis and surgical treatment of gastropericardial fistulae are essential to avoid fatal complications.

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“…51 Indeed, most of the reported cases of gastric tube ulcers did not involve pain, [7][8][9][10][11][12][13][14][15][16][17][18][51][52][53][54] so that ulcers of the gastric tube may be less frequently painful than ordinary gastric ulcers. However, the mechanism of ulcer pain remains controversial.…”

Section: Reasons For the Absence Of Pain In Gastric Tube Ulcersmentioning

confidence: 99%

“…[7][8][9][10][11][12][13][14][15][16][17] The characteristics of the cases of perforated gastric tube after esophagectomy for esophageal cancer are presented in Table 1. Cases #6 12 and #11 15 had been taking an H2-blocker and nonsteroidal anti-infl ammatory drugs (NSAIDs), respectively, before the gastric tube was perforated, and the latter patient had a history of gastric ulcers.…”

Section: Case Reports On Perforated Gastric Tubesmentioning

confidence: 99%

Gastric tube perforation after esophagectomy for esophageal cancer

et al. 2011

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We searched for cases of perforation of the gastric tube after esophagectomy for esophageal cancer by reviewing the literature. Only 13 cases were found in the English literature, and serious complications were seen in all cases, especially in cases of posterior mediastinal reconstruction. However, in the Japanese literature serious complications were also frequently seen in retrosternal reconstruction. Gastric tubes are at a higher risk of developing an ulcer than the normal stomach, including an ulcer due to Helicobacter pylori infection, insufficient blood supply, gastric stasis, and bile juice regurgitation. H. pylori eradication and acid-suppressive medications are important preventive therapies for ordinary gastric ulcers, but for gastric tube ulcers the effects of such treatments are still controversial. We tried to determine the most appropriate treatment to avoid serious complications in the gastric tubes, but we could not confirm an optimal route because each had advantages and disadvantages. However, at least in cases with severe atrophic gastritis due to H. pylori infection or a history of frequent peptic ulcer treatment, the antesternal route is clearly the best. Many cases of gastric tube ulcers involve no pain, and vagotomy may be one of the reasons for this absence of pain. Therefore, periodic endoscopic examination may be necessary to rule out the presence of an ulcer.

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Occurrence of peptic ulcer in the gastric tube used for esophageal replacement in adults

Cited by 33 publications

References 6 publications

Refractory Ulcer of Reconstructed Gastric Tube after Esophagectomy: A Case Report

Refractory Ulcer of Reconstructed Gastric Tube after Esophagectomy: A Case Report

Gastropericardial fistula resulting from ulcerative perforation of the reconstructed gastric tube after surgery for esophageal cancer

Gastric tube perforation after esophagectomy for esophageal cancer

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