title: Gastric surgery is not a risk factor for erosive esophagitis or Barrett's esophagus.
abstract: 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.
authors.affiliation: Department of Gastroenterology, Tokyo Metropolitan Hiroo Hospital, Tokyo, Japan.
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Akiyama
authors.forename: Masahiko
authors.initials: M
authors.lastname: Inamori
authors.forename: Keiko
authors.initials: K
authors.lastname: Akimoto
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Iida
authors.forename: Hiroki
authors.initials: H
authors.lastname: Endo
authors.forename: Kunihiro
authors.initials: K
authors.lastname: Hosono
authors.forename: Tamon
authors.initials: T
authors.lastname: Ikeda
authors.forename: Yasunari
authors.initials: Y
authors.lastname: Sakamoto
authors.forename: Koji
authors.initials: K
authors.lastname: Fujita
authors.forename: Masato
authors.initials: M
authors.lastname: Yoneda
authors.forename: Tomoko
authors.initials: T
authors.lastname: Koide
authors.forename: Hirokazu
authors.initials: H
authors.lastname: Takahashi
authors.forename: Chikako
authors.initials: C
authors.lastname: Tokoro
authors.forename: Ayumu
authors.initials: A
authors.lastname: Goto
authors.forename: Yasunobu
authors.initials: Y
authors.lastname: Abe
authors.forename: Noritoshi
authors.initials: N
authors.lastname: Kobayashi
authors.forename: Kensuke
authors.initials: K
authors.lastname: Kubota
authors.forename: Satoru
authors.initials: S
authors.lastname: Saito
authors.forename: Akihiko
authors.initials: A
authors.lastname: Moriya
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Rino
authors.forename: Toshio
authors.initials: T
authors.lastname: Imada
authors.forename: Atsushi
authors.initials: A
authors.lastname: Nakajima
mesh_terms: 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