title: Anti-reflux anastomosis following esophagectomy for adenocarcinoma of the esophagogastric junction: impact of duodenogastroesophageal reflux and expression of cyclooxygenase-2 in the remnant esophagus.
abstract: OBJECTIVE
  Reflux is the principal complication for patients after esophagectomy with gastric reconstruction. The aim of this study was to investigate the effect of the modified Nissen fundoplication after resection of adenocarcinoma from the esophagogastric junction (AEG) on controlling the reflux and the role of duodenogastroesophageal reflux (DGER) and cyclooxygenase-2 (COX-2) expression level in the remnant esophagus.
  
  
  METHODS
  Sixty patients with AEG were randomly divided into two groups: (i) the conventional anastomosis group and (ii) the anti-reflux anastomosis group. Fifty esophagectomized patients were invited to participate in postoperative follow-up after 6 to 12 months. Among those we had 29 cases in the conventional anastomosis group and 21 in the anti-reflux anastomosis group. We used endoscopy, simultaneous 24 hours esophageal pH and bilirubin monitoring in this study. The COX-2 expression level in the remnant esophagus was detected using real-time PCR.
  
  
  RESULTS
  The reflux esophagitis prevalence in anti-reflux anastomosis group was comparable to that in the conventional group (p = 0.154). DeMeester score and fraction time of bilirubin abs >0.14 decreased more intensely in the anti-reflux anastomosis group (p < 0.05). The COX-2 expression level in of anti-reflux anastomosis group was evidently lower than that in the conventional anastomosis group (p = 0.022) while it was meaningfully higher compared to the normal control group (p = 0.046). COX-2 up-regulation as well as high prevalence of esophagitis were observed in simultaneous acid reflux and DGER (p < 0.05).
  
  
  CONCLUSIONS
  Although modified fundoplication following resection of AEG did not achieve an optimal effect on controlling reflux, it was very effective in decreasing the reflux. COX-2 expression monitoring can be considered as a possible new way to evaluate the impact of anti-reflux surgery. DGER occurring in acidic environment could develop severe reflux esophagitis and up-regulate the COX-2 expression.
authors.affiliation: Department of Thoracic Surgery, First People's Hospital in XuZhou City, XuZhou, China. wangjd165@163.com.
authors.forename: J-D
authors.initials: JD
authors.lastname: Wang
authors.forename: S-Y
authors.initials: SY
authors.lastname: Zhu
authors.forename: Y-J
authors.initials: YJ
authors.lastname: Lu
authors.forename: L-Y
authors.initials: LY
authors.lastname: Gao
mesh_terms: D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical / Q000379:methods; D051546:Cyclooxygenase 2 / Q000096:biosynthesis*; D004383:Duodenogastric Reflux / Q000201:enzymology* / Q000601:surgery; D004938:Esophageal Neoplasms / Q000201:enzymology* / Q000601:surgery; D016629:Esophagectomy / Q000379:methods*; D004943:Esophagogastric Junction / Q000201:enzymology / Q000601:surgery; D005260:Female; D018662:Fundoplication / Q000379:methods; D005764:Gastroesophageal Reflux / Q000201:enzymology* / Q000601:surgery; D015972:Gene Expression Regulation, Neoplastic; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology; D013274:Stomach Neoplasms / Q000201:enzymology* / Q000601:surgery
chemical_list: D051546:Cyclooxygenase 2; C496540:PTGS2 protein, human