Gastric surgery is not a risk factor for erosive esophagitis or Barrett's esophagus.
OBJECTIVE
The role of gastric acid reflux is difficult to separate from that of pancreatic-biliary reflux in the pathogenesis of erosive esophagitis (EE) and Barrett's esophagus (BE). Gastric surgery patients provide a good model for both significant pancreatic-biliary reflux and marked gastric acid inhibition. We assessed the risk of EE and BE after distal gastrectomy in a case-controlled study.


METHODS
One hundred and sixty patients (121 men, 39 women; median age 68 years; range 32-86 years) with distal gastrectomies (Billroth-I) and 160 sex- and age-matched controls with intact stomachs were enrolled. The presence of EE and BE were diagnosed based on the Los Angeles Classification and the Prague C & M Criteria, respectively. A conditional logistic regression model with adjustments for potential confounding factors was used to assess the associations.


RESULTS
According to the multivariate analyses, patients with distal gastrectomies tended to have inverse associations with the risks of EE and BE, and the inverse association with the risk of BE reached a significant level.


CONCLUSIONS
Distal gastrectomy is not a risk factor for the development of EE and BE. This lack of a positive association between distal gastrectomy and EE and BE may suggest that pancreatic-biliary reflux with a limited amount of acid is not sufficient to damage the esophageal mucosa.
Akiyama
Tomoyuki
T
Department of Gastroenterology, Tokyo Metropolitan Hiroo Hospital, Tokyo, Japan.
Inamori
Masahiko
M
Akimoto
Keiko
K
Iida
Hiroshi
H
Endo
Hiroki
H
Hosono
Kunihiro
K
Ikeda
Tamon
T
Sakamoto
Yasunari
Y
Fujita
Koji
K
Yoneda
Masato
M
Koide
Tomoko
T
Takahashi
Hirokazu
H
Tokoro
Chikako
C
Goto
Ayumu
A
Abe
Yasunobu
Y
Kobayashi
Noritoshi
N
Kubota
Kensuke
K
Saito
Satoru
S
Moriya
Akihiko
A
Rino
Yasushi
Y
Imada
Toshio
T
Nakajima
Atsushi
A
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001471:Barrett Esophagus / Q000175:diagnosis / Q000209:etiology*; D001660:Biliary Tract Diseases / Q000150:complications; D016022:Case-Control Studies; D004941:Esophagitis / Q000175:diagnosis / Q000209:etiology*; D004945:Esophagoscopy; D005260:Female; D005743:Gastrectomy; D005773:Gastroscopy; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010182:Pancreatic Diseases / Q000150:complications; D012189:Retrospective Studies; D012307:Risk Factors; D018709:Statistics, Nonparametric