title: Preoperative gastric acid secretion and the risk to develop Barrett's esophagus after esophagectomy for chagasic achalasia.
abstract: BACKGROUND
  The aim of this study was to determine the contribution of preoperative gastric secretory and hormonal response, to the appearance of Barrett's esophagus in the esophageal stump following subtotal esophagectomy.
  
  
  METHODS
  Thirty-eight end-stage chagasic achalasia patients submitted to esophagectomy and cervical gastric pull-up were followed prospectively for a mean of 13.6 +/- 9.2 years. Gastric acid secretion, pepsinogen, and gastrin were measured preoperatively in 14 patients who have developed Barrett's esophagus (Group I), and the results were compared to 24 patients who did not develop Barrett's esophagus (Group II).
  
  
  RESULTS
  In the group (I), the mean basal and stimulated preoperative gastric acid secretion was significantly higher than in the group II (basal: 1.52 vs. 1.01, p = 0.04; stimulated: 20.83 vs. 12.60, p = 0.01). Basal and stimulated preoperative pepsinogen were also increased at the Group I compared to Group II (Basal = 139.3 vs. 101.7, p = 0.02; stimulated = 186.0 vs. 156.5, p = 0.07. There was no difference in preoperative gastrin between the two groups. Gastritis was present during endoscopy in 57.1% of the Group I, while it was detected in 16.6% of the Group II, p = 0.014.
  
  
  CONCLUSIONS
  Barrett's esophagus in the esophageal stump was associated to high preoperative levels of gastric acid secretion, serum pepsinogen, and also gastritis in the transposed stomach.
authors.affiliation: Digestive Surgery Division, Department of Gastroenterology, University of São Paulo School of Medicine, São Paulo, Brazil. jrmarian@terra.com.br
authors.forename: Julio Rafael Mariano
authors.initials: JR
authors.lastname: da Rocha
authors.forename: Ivan
authors.initials: I
authors.lastname: Cecconello
authors.forename: Ulysses
authors.initials: U
authors.lastname: Ribeiro
authors.forename: Elisa R
authors.initials: ER
authors.lastname: Baba
authors.forename: Adriana Vaz
authors.initials: AV
authors.lastname: Safatle-Ribeiro
authors.forename: Kiyoshi
authors.initials: K
authors.lastname: Iriya
authors.forename: Rubens A A
authors.initials: RA
authors.lastname: Sallum
authors.forename: Paulo
authors.initials: P
authors.lastname: Sakai
authors.forename: Sérgio
authors.initials: S
authors.lastname: Szachnowicz
mesh_terms: D000328:Adult; D001471:Barrett Esophagus / Q000453:epidemiology* / Q000209:etiology / Q000473:pathology; D014355:Chagas Disease / Q000150:complications; D004848:Epithelium / Q000473:pathology; D004931:Esophageal Achalasia / Q000150:complications / Q000175:diagnosis / Q000469:parasitology / Q000601:surgery*; D016629:Esophagectomy / Q000379:methods; D005260:Female; D005744:Gastric Acid / Q000378:metabolism*; D005755:Gastrins / Q000097:blood; D006801:Humans; D008297:Male; D008875:Middle Aged; D020116:Pepsinogen A / Q000097:blood; D057234:Preoperative Period; D018570:Risk Assessment; D055815:Young Adult
chemical_list: D005755:Gastrins; D020116:Pepsinogen A