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Background: Gastrectomy is the most common gastrointestinal surgery in Japan. Thoracic esophageal cancer in patients who underwent surgery has a history of gastrectomy in 3–10% of cases. Whether postgastrectomy conditions lead to esophageal carcinogenesis is controversial. This study examined whether reflux of duodenal juice to the esophagus was involved in esophageal carcinogenesis. Methods: Eight-week male Wistar rats were exposed to duodenal content esophageal reflux. All animals underwent an esophagoduodenal anastomosis (EDA) with total gastrectomy to elicit chronic esophagitis. In ten rats sham operations were performed (Control). These rats were sacrificed at the 40th week, their esophagi were taken for hematoxylin and eosin staining and for examination of expression of cyclooxygenase 2 (COX2), oxidative stress [malondialdehyde (MDA), superoxide dismutase (SOD), glutathione (GSH)] and bile acids in esophageal lumen and common bile duct. Results: After 40th week, columnar dysplasia, squamous cell carcinoma (SCC) and adenocarcinoma (ADC) were observed. Total bile acids in the esophageal lumen were significantly higher in EDA rat compared to Control rat. Moreover, from the point of bile acids in common bile duct, taurocholic acid (TCA), taurodeoxycholic acid (TDCA), taurochenodeoxycholic acid (TCDCA) and tauroursodeoxycholic acid (TUDCA) in EDA rat are significantly higher than those in control rat. The mucosal MDA level of EDA rat was significantly higher than that of the control rat. GSH and SOD levels were significantly reduced in the EDA rat compared to the control rat. Lipid peroxidation in the esophageal epithelium was significantly higher in the EDA rat than that of control rat. Overexpression of COX2 was observed in dysplastic and cancer tissues. Conclusions: Reflux of duodenal contents, especially bile acids, TCA, TDCA, TCDCA and TUDCA caused oxidative stress, subsequently induces COX2, and induced esophageal carcinogenesis in EDA rat model.

annals of esophagus

Bile acids (taurocholic acid, taurodeoxycholic acid, taurochenodeoxycholic acid, tauroursodeoxycholic acid) develop esophageal cancer in a rat model of duodenoesophageal anastomosis after total gastrectomy