Received: 15.02.2010 Accepted: 25.05.2010 J Gastrointestin Liver Dis September 2010 Vol.19 No 3, 247-252 Address for correspondence: Prof. Vasile Andreica 3rd Medical Clinic Croitorilor str, no 19-21 400162, Cluj, Romania Email:andreicav@umfcluj.ro Alkaline Relux Esophagitis in Patients with Total Gastrectomy and Roux en Y Esojejunostomy Daniela Matei 1 , Razvan Dadu 1 , Raluca Prundus 1 , Ioana Danci 2 , Lidia Ciobanu 1 , Teodora Mocan 3 , Corina Bocsan 4 , Roxana Zaharie 1 , Alexandru Serban 1 , Marcel Tantau 1 , Cornel Iancu 5 , Irimie Alexandru 6 , Nadim Al-Hajjar 5 , Vasile Andreica 1 1) 3rd Medical Clinic; 2) 5th Medical Clinic; 3) Pathophysiology Department; 4) Pharmacology Department; 5) 3rd Surgery Clinic, University of Medicine and Pharmacy „Iuliu Haţieganu”; 6) „I. Chiricuta” Institute of Oncology, Cluj Napoca, Romania Abstract Background and Aims. Alkaline relux esophagitis is a complication that might develop in patients with total gastrectomy. The aim of the study was to analyze the prevalence and severity of relux esophagitis and the occurence of complications (Barrett’s esophagus and esophageal stenosis) in patients with total gastrectomy and Roux en Y esojejunostomy. Methods. 92 patients with total gastrectomy performed for gastric cancer were included in the study. None of the patients had esophagitis prior to gastrectomy. The patients were assessed clinically and endoscopically after a certain interval from surgery. Results. An important number of patients (14 out of 92, 15.22%) had relux esophagitis; 5.43% of the patients had also complications of relux esophagitis (Barrett’s esophagus and benign esophageal stenosis) and 6.52% had local tumor recurrence. Of the 14 patients with relux esophagitis, the majority (9/14) had Los Angeles (LA) grade C esophagitis. The mean interval between surgery and the endoscopic evaluation was 4.43 years. Barrett’s esophagus and benign stenosis were diagnosed after a longer period of time (10.33 and 8 years, respectively) as compared to relux esophagitis (5.29 years). More than half of the esophagitis patients had relux symptoms. Conclusions. Although Roux en Y esojejunostomy is a reconstructive technique which prevents the relux, an important percentage of our patients developed alkaline relux esophagitis. In most cases, the esophagitis was moderate or severe. Complications of alkaline relux, i.e. benign stenosis and Barrett’s esophagus, also occurred after longer periods of time (8 to 10 years) in a small percentage of patients. oRiGinAl PAPERs Key words Alkaline relux esophagitis – total gastrectomy – Roux en Y esojejunostomy – gastric cancer – Barrett’s esophagus – esophageal stenosis. introduction Alkaline relux esophagitis is a complication occurring after total gastrectomy. Its postoperative incidence depends on the type of reconstructive surgery. Roux- en-Y esophagojejunostomy is the preferred method of reconstruction because it is followed by a lower rate of alkaline esophagitis as compared to other procedures (simple esophagojejunostomy, esophagoduodenostomy) [1-3]. The length of the jejunal loop (i.e., the distance between the esophagojejunostomy and the site where the duodenal content enters the alimentary tract) has a determining role in preventing the relux. It is considered that the length of the loop must be of at least 35-40 cm, preferably over 50 cm [1, 4, 5]. This type of reconstruction allows the food progression from the esophagus to the intestine and also prevents alkaline relux into the esophagus [6, 7]. The role of the different components of the reluxate in the pathogenesis of alkaline esophagitis is only partially known. Some studies in animals showed that trypsin, deconjugated bile salts, and lysolecithin are more damaging to the esophagus in the absence of gastric acid [8]. Clinical signs and symptoms such as heartburn, bitter taste, regurgitation suggest the presence of relux esophagitis. Esophagoscopy is considered the golden standard for the diagnosis of esophagitis. In the absence of esophagitis, the relux is usually asymptomatic [9]. In the evolution of patients with alkaline reflux esophagitis, certain complications can occur. The most frequent are Barrett’s esophagus and stenosis. The acid relux has been considered to be the main cause for Barrett’s esophagus [10], but recent studies revealed that alkaline relux could also play an important role in the development of this condition [11]. In the present study we analyze the prevalence