Effect of trypsin inhibitor on reflux oesophagitis after total gastrectomyin rats

Objective: To characterise alkaline reflux oesophagitis after total gastrec tomy in rats from the standpoints of cell proliferation and apoptosis and f rom its macroscopic and microscopic findings, and to evaluate the preventiv e and curative effects of camostat mesilate, a trypsin inhibitor. Design: Open laboratory study. Setting: University hospital, Japan. Animals: 70 male Wistar rats. Interventions: Total gastrectomy with Billroth II anastomosis (n = 30) and with Roux-en-Y anastomosis (n = 30) were used to establish reflux oesophagi tis. Camostat mesilate was given for prevention and cure. The remaining 10 animals had a sham operation. Main outcome measures: Trypsin activity of the oesophagus, macroscopic and microscopic findings, bromodeoxyuridine (BrdU) and apoptotic cell labelling indices. Results: Reflux oesophagitis was more common and extensive after Billroth I I than Roux-en Y anastomosis. The BrdU labelling index was increased in oes ophagitis, while the apoptotic index did not change. Camostat mesilate was effective in both preventing and treating oesophagitis. Conclusion: Trypsin has an important role in the development of reflux oeso phagitis after total gastrectomy.