Duodenoesophageal reflux induces esophageal adenocarcinoma without exogenous carcinogen.
Duodenoesophageal reflux induces esophageal adenocarcinoma without exogenous carcinogen.
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DOI：
10.1016/s1091-255x(98)80021-8
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发表时间：
1998-05-01
期刊：
影响因子：
--
通讯作者：
DeMeester, T R
中科院分区：
文献类型：
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作者：
Fein, M;Peters, J H;DeMeester, T R
在大鼠模型中，食管腺癌在手术诱导的十二指肠反流进入食管和亚硝胺给药后可重复发生。此外，通过部分或全胃切除术减少胃酸会增加该模型中腺癌的患病率。我们质疑致癌物是否是胃切除模型中癌症发展所必需的，以及食管酸化是否可以逆转胃切除术的效果。将三组大鼠（每组26只）随机分配至外科手术，以产生以下反流模型之一：通过食管空肠吻合术产生胃十二指肠反流，通过全胃切除术和食管空肠吻合术产生十二指肠反流，或通过Roux-en-Y重建术产生无反流。在第二个实验中，对42只大鼠进行了诱导十二指肠反流的手术。手术后一周，他们被随机分配接受酸化水（pH 1.8）或自来水。在24周龄时处死动物，并对食管进行组织学评价。所有反流动物都有严重的食管炎，87%的远端食管出现柱状衬里。近一半（48%）在术后16周的吻合口部位发生腺癌，且未给予致癌物。胃十二指肠或十二指肠反流动物之间的癌症患病率没有差异，但接受酸化水的动物往往较低。十二指肠食管反流在大鼠模型中具有致癌性。外源性致癌物不是胃切除大鼠癌变的必要条件。
In the rat model, esophageal adenocarcinoma reproducibly develops following surgically induced duodenal reflux into the esophagus and administration of nitrosamine. In addition, decreasing gastric acid via partial or total gastrectomy increases the prevalence of adenocarcinoma in this model. We questioned whether carcinogen was necessary for cancer development in the gastrectomized model and whether esophageal acidification could reverse the effect of gastrectomy. Three groups of 26 rats each were randomized to a surgical procedure to produce one of the following reflux models: gastroduodenal reflux by esophagojejunostomy, duodenal reflux by total gastrectomy and esophagojejunostomy, or no reflux by Roux-en-Y reconstruction. In a second experiment, 42 rats were operated on to induce duodenal reflux. One week following surgery, they were randomized to receive acidified water (pH 1.8) or tap water. The animals were killed at 24 weeks of age, and the esophagus was evaluated histologically. All animals with reflux had severe esophagitis and 87% developed columnar lining of the distal esophagus. Nearly half (48%) developed adenocarcinoma at the anastomotic site 16 weeks postoperatively and without carcinogen administration. Cancer prevalence did not differ between animals with gastroduodenal or duodenal reflux but tended to be lower in animals receiving acidified water. Duodenoesophageal reflux is carcinogenic in the rat model. Exogenous carcinogen is not necessary for cancer development in gastrectomized rats.