Postoperative reflux esophagitis is usually not seen in connection with Roux-en-Y
reconstruction after total or subtotal gastrectomy. An isoperistaltic jejunal limb
of adequate length (over 40 cm) is considered to prevent reflux of duodenal contents
into the esophagus with consequent injury of the esophageal mucosa that otherwise
may ensue. The present paper describes four patients who developed postoperative reflux
esophagitis as a complication after total gastrectomy, despite a well-functioning
Roux-en-Y reconstruction. It is possible that the intra-abdominal generalization of
cancer which was concomitantly observed in three of our four patients, may have had
a contributary influence on the development of the condition by decreasing esophageal
mucosal resistance, thus rendering the mucosa vulnerable to even minimal amounts of
intra-esophageal regurgitation of duodenal contents, and that alkaline reflux esophagitis
appearing after an interval in a patient who had an adequate Roux-en-Y reconstruction
after total gastrectomy, may be the first sign of intra-abdominal tumor recurrence
despite negative x-ray examinations.
Total gastrectomy - Roux-en-Y reconstruction - Postoperative reflux - Esophagitis
- Trypsin
