Reflux esophagitis after esophagectomy: impact of duodenogastroesophageal reflux.

Reflux esophagitis (RE) is a known complication disturbing patients' quality of life after esophageal resection. It is generally recognized that bile reflux as well as acid reflux cause RE. However, the clinical influence of acid and bile reflux, and Helicobacter pylori (H. pylori) infection on RE in the cervical esophagus after esophagectomy is not yet clarified. Sixty patients who underwent cervical esophagogastrostomy following esophagectomy were enrolled in this study. They underwent examination for H. pylori infection, endoscopic examination, and continuous 24-hour pH and bilirubin monitoring, at 1 month after surgery. The influence of acid and/or bile reflux, H. pylori infection, and others on the development of RE were investigated. RE was observed in 19 patients (32%) at 1 month after esophagogastrostomy, mild RE in 16 (27%), and severe RE in 3 (5%). The percentage of time duration of both acid and bile reflux into the cervical esophagus was higher in patients with RE than in those without (P = 0.027, P < 0.001). A significant difference in %time pH < 4 acid reflux was found between mild RE and severe RE (P = 0.014), and a statistical difference in %time abs. > 0.14 between non-RE and mild RE (P = 0.017). Acid and/or bile reflux was observed in 31 patients (52%), acid-only reflux in 6 (10%), bile-only reflux in 15 (25%), and acid-and-bile reflux in 10 (17%). Severe RE was observed only in patients having acid-and-bile reflux. On the univariate analysis, no infection of H. pylori, acid reflux, and bile reflux were determined to be the influencing factors to RE among the clinical factors including age, gender, route of esophageal reconstruction, H. pylori infection, and acid-and-bile reflux. In the subanalysis using the logistic model, there were significant correlations between bile reflux and RE irrespective of the presence of H. pylori infection (P = 0.016, P = 0.007). On the other hand, there was a significant correlation between acid reflux and RE only in patients without H. pylori infection (P = 0.039). In the early period after esophagogastrostomy, bile reflux could cause RE irrespective of H. pylori infection, while acid reflex could cause RE only in patients without H. pylori infection. There is a possibility that bile reflux plays an important role in the development of RE after esophagectomy.

What influences the acidity in the gastric conduit in patients who underwent cervical esophagogastrostomy for cancer?

The aim of this study was to determine the factors influencing acidity in the gastric conduit after esophagectomy for cancer. Acidity and bile reflux in the stomach and in the gastric conduit were examined by 24-h pH monitoring and bilimetry in 40 patients who underwent transthoracic subtotal esophagectomy followed by esophageal reconstruction using a gastric conduit, which was pulled up to the neck through a posterior mediastinal route in 17 patients, through a retrosternal route in 10 patients, and through a subcutaneous route in 13 patients. They were examined at 1 week before surgery, at 1 month after surgery, and at 1 year after surgery. Helicobacter pylori infection was examined pathologically and using the (13) C-urea breath test. The factors influencing acidity of the gastric conduit were analyzed using the stepwise regression model. Gastric acidity assessed by percentage (%) time of pH < 4 was reduced after surgery and was significantly less in patients with H. pylori infection compared with those without H. pylori infection throughout the period from 1 week before surgery to 1 year after surgery. Duodenogastric reflux (DGR) assessed by % time absorbance > 0.14 into the lower portion of the gastric conduit was significantly increased after surgery throughout the period from 1 month after surgery to 1 year after surgery. Multivariate analysis showed that the acidity in the gastric conduit was influenced by H. pylori infection and DGR at 1 month after surgery, and by H. pylori infection and the route for esophageal reconstruction at 1 year after surgery. Acidity in the gastric conduit was significantly decreased after surgery. Acidity in the gastric conduit for esophageal substitutes is influenced by H. pylori infection and surgery. DGR influences the gastric acidity in the short-term after surgery, but not in the long-term after surgery.

Flavor characteristics of glutathione in raw and cooked foodstuffs.

The flavor of glutathione (gamma-L-glutamyl-L-cysteinylglycine, GSH) was examined by several sensory evaluations. The measurement of a point of subjective equality (PSE) showed that the peptide increases the flavor characteristics but did not affect the intensity of basic tastes, such as sweetness, saltiness, sourness, and umami. However, the threshold value of GSH decreased significantly in an umami solution containing 0.05% each of monosodium glutamate (MSG) and disodium inosinate (IMP). This suggests that GSH interacts with the umami substance and has a certain effect on the flavor. GSH had a characteristic kokumi flavor, such as continuity, mouthfulness, and thickness in the umami solution as well as in a model beef extract constructed from analyzed components at a concentration of 0.02% w/v. Some foodstuffs, including meat, were found to contain GSH above its threshold value, which implicates the contribution of GSH to the flavor. The thermal degradation study suggested that a part of GSH have changed into its disulfide, pyroglutamic acid (PCA), and cyclocysteinylglycine in cooked foodstuffs.

Composition of Sulfur-Containing Components in Onion and Their Flavor Characters.

Sulfur-containing components in an ethanol extract and boiled water extract of onion (Allium cepa L.) were analyzed by HPLC. Trans-(+)-S-propenyl-l-cysteine sulfoxide (PeCSO) and its γ-glutamyl peptide (γ-Glu-PeCSO) were the major constituents in the ethanol extract, whereas cycloalliin was the most abundant one in the boiled water extract. The large amount of cycloalliin found in the boiled water extract was mostly derived from PeCSO by heating. PeCSO and γ-Glu-PeCSO showed a characteristic kokumi flavor (continuity, thickness, and mouthfulness) by a sensory test in an umami solution containing 0.05% (w/v) each of monosodium glutamate and disodium inosinate.