The Role of Bile Acid and Pancreatic Juice for Reflux Esophagitis After Total Gastrectomy in Rat Model

Background After total gastrectomy, esophagitis develops, depending on the type of reconstruction. Reflux of duodenal contents contributes to the development of esophageal mucosal lesion. Esophagitis after total gastrectomy has been associated with the reflux of duodenal content (biliary and pancreatic juice) into the esophagus. This study is to determine which fraction of the duodenum content reflux, pancreatic juice or bile acids contributes to the development of reflux esophagitis. Methods 8 week Wistar Rat were used. After 3 weeks, the rats were sacrificed and esophageal specimens were taken to examine the degree of macroscopic and microscopic damage. Results 1.Macroscopic finding: In TG, the middle and lower esophageal wall was thickened and shortened due to sever inflammation. Esophageal wall was covered with moss and a cobblestone appearance was observed. However, the gross appearance of the esophagus from TG + B and TG + P showed only scattered erosions. The ulcer score in TG + B and TG + P were significantly lowered compared to TG. 2. Microscopic finding: TG developed large and long longitudinal ulcers, sever infiltration of inflammatory cells. The inflammatory cell infiltration scores and hyperplasia scores were significantly decreased in the TG + B and TG + P group compared to TG. Conclusion The reflux of pancreatic juice alone and bile acid alone are probably not significant development of reflux esophagitis after total gastrectomy. The reflux of bile acid mixed with pancreatic juice to esophagus caused sever reflux esophagitis after total gastrectomy.