Miwa K, Sahara H, Segawa M, Kinami S, Sato T, Miyazaki I, Hattori T
Department of Surgery II, School of Medicine, Kanazawa University, Japan.
Int J Cancer. 1996 Jul 17;67(2):269-74. doi: 10.1002/(SICI)1097-0215(19960717)67:2<269::AID-IJC19>3.0.CO;2-6.
Esophageal adenocarcinoma arises from Barrett's esophagus, which is induced by gastro-esophageal reflux. This refluxate often contains duodenal contents, whose backflow triggers gastric carcinoma, suggesting the hypothesis that refluxed duodenal contents cause esophageal carcinoma. This study examines the role of duodenal and gastric reflux in the absence of exogenous carcinogens in esophageal carcinogenesis. Wistar male rats, 120 in all, each weighing approximately 250 g, were used. Three experimental procedures were performed to produce gastro-duodeno-esophageal reflux, duodeno-esophageal reflux and gastro-esophageal reflux, for comparison with 2 control procedures, Roux-en-Y reconstruction and a sham operation. The animals were fed a standard diet and were examined 50 weeks after surgery. While no carcinoma was found among the 16 gastro-esophageal-reflux, 11 Roux-en-Y and 12 sham-operation animals, 10 of the 12 animals with gastro-duodeno-esophageal reflux (83%) and 10 of the 13 with duodeno-esophageal reflux (77%) developed esophageal carcinoma. The difference between groups was significant (p < 0.001). Two animals with gastro-duodeno-esophageal reflux had esophageal double and triple carcinomas respectively. Of the 23 carcinomas, 16 were adenocarcinoma, 4 adenosquamous carcinoma, and 3 squamous-cell carcinoma. Adenocarcinoma developed from the columnar-lined epithelium near the esophago-jejunostoma, while adenosquamous and squamous-cell carcinoma arose from the squamous esophagitis. These observations demonstrate that refluxed duodenal contents per so are responsible for esophageal carcinogenesis.
食管腺癌起源于巴雷特食管，后者由胃食管反流引起。这种反流物通常含有十二指肠内容物，其反流会引发胃癌，这提示了反流的十二指肠内容物导致食管癌的假说。本研究探讨在无外源性致癌物情况下十二指肠和胃反流在食管癌发生中的作用。共使用120只雄性Wistar大鼠，每只体重约250克。进行了三种实验操作以产生胃十二指肠食管反流、十二指肠食管反流和胃食管反流，与两种对照操作（Roux-en-Y重建和假手术）进行比较。动物喂食标准饮食，并在手术后50周进行检查。在16只进行胃食管反流、11只进行Roux-en-Y重建和12只进行假手术的动物中未发现癌，但在12只进行胃十二指肠食管反流的动物中有10只（83%）以及13只进行十二指肠食管反流的动物中有10只（77%）发生了食管癌。组间差异具有显著性（p<0.001）。两只进行胃十二指肠食管反流的动物分别发生了食管双重癌和三重癌。在23例癌中，16例为腺癌，4例为腺鳞癌，3例为鳞状细胞癌。腺癌由食管空肠吻合口附近的柱状上皮发展而来，而腺鳞癌和鳞状细胞癌则起源于鳞状食管炎。这些观察结果表明，单纯反流的十二指肠内容物是食管癌发生的原因。
