INCREASED CHEMILUMINESCENCE AND ULCER DEVELOPMENT IN THE LOW BLOOD-FLOW STATE OF THE GASTRIC TUBE FOR ESOPHAGEAL REPLACEMENT

Peptic ulcers in the gastric tube for esophageal replacement develop i n spite of reduction of acid secretion after truncal vagotomy and ofte n result in serious conditions such as bleeding and perforation. Thirt een cases of gastric tube ulcers were detected endoscopically from 198 5 to 1990 in our hospital. Most of these ulcers developed within 20 cm of the anastomosis (esophagogastrostomy), which was an especially hyp oxic and ischemic area. Ischemic change due to decreased blood supply is suggested as a causative factor in ulcer development. Recent studie s indicate that chemiluminescence (ChL) activity may increase even in the low-flow hypoxic condition. Therefore, we investigated the ChL of regional blood in the hypoxic gastric tube in dogs. The ChL activity o f the blood sample collected from the ischemic region in the gastric t ube significantly increased after construction of the gastric tube, co mpared with systemic blood from the femoral vein, and the number of le ukocytes decreased in the ischemic region. We believe that oxygen radi cals derived from neutrophils adhering to the vascular endothelium may play an important role in the damage to endothelial cells of the gast ric tube and suggest the possibility of their causative effects in the process of ulcer formations.