Abstract
To analyze the late results of advanced Chagasic megaesophagus treatment by esophagectomy associated with the use of proton pump inhibitor (omeprazole) as for the incidence of esophagitis and Barrett's esophagus in the remaining stump. We studied patients with advanced megaesophagus undergoing esophagectomy and transmediastinal esophagogastroplasty. Patients were divided into three groups: A (20) with esophageal replacement by full stomach, without the use of omeprazole; B (20) with esophageal replacement by full stomach, with omeprazole 40 mg/day introduced after the first postoperative endoscopy and maintained for six years; and C (30) with esophageal replacement by gastric tube with use of omeprazole. Dysphagia, weight loss and BMI were clinical parameters we analyzed. Upper gastrointestinal endoscopy was performed in all patients, and determined the height of the anastomosis, the aspect of the mucosa, with special attention to possible injuries arising from gastroesophageal reflux, and the patency of the esophagogastric anastomosis. We studied 50 patients, 28 males (56%) and 22 (44%) females. All underwent endoscopy every year. In the first endoscopy, erosive esophagitis was present in nine patients (18%) and Barrett's esophagus, in four (8%); in the last endoscopy, erosive esophagitis was present in five patients (8%) and Barrett's esophagus in one (2%). When comparing groups B and C, there was no evidence that the manufacturing of a gastric tube reduced esophagitis and Barrett's esophagus. However, when comparing groups A and C, omeprazole use was correlated with reduction of reflux complications such as esophagitis and Barrett's esophagus (p <0.005). The use of omeprazole (40 mg/day) reduced the onset of erosive esophagitis and Barrett's esophagus during the late postoperative period.
Highlights
The esophagus is the organ most commonly affected by Chagas disease in the digestive tract
This research aims to analyze the late results of advanced Chagasic megaesophagus treatment by esophagectomy associated with pump inhibitor (PPI), targeted at the incidences of esophagitis and Barrett’s esophagus in the remaining stump
The use of proton pump inhibitor was done at a dose of 40 mg/day for all patients undergoing esophagectomy operated from 2006 on
Summary
The esophagus is the organ most commonly affected by Chagas disease in the digestive tract. The first proposal for the surgical treatment of achalasia was made by Gottstein, which indicated cardiomyotomy[5] It was Heller who consecrated the procedure, with section of the muscles in the anterior and posterior aspects of the esophagus[6]. Oberg proved that despite truncal vagotomy, there was no long-term suppression of acid reflux Corroborating this statement, Rocha et al described erosive esophagitis and Barrett’s esophagus in patients undergoing esophagectomy with gastroplasty. They suggested that longterm treatment with proton pump inhibitor could avoid such complications[26]. This research aims to analyze the late results of advanced Chagasic megaesophagus treatment by esophagectomy associated with PPIs (omeprazole), targeted at the incidences of esophagitis and Barrett’s esophagus in the remaining stump
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
