A 51-year-old man who underwent esophagectomy for intrathoracic esophageal cancer and reconstruction of gastric tube in January 1994 and had postoperative radiotherapy, was admitted to Keio University Hospital with a complaint of hematemesis and tarry stool in November 1995.
Endoscopic examination showed a easily bled multiple erosions in the gastric tube. He was treated with proton pump inhibitor (PPI) and H2 receptor antagonist (H2RA) , but failed. Endoscopic laser-Doppler flowmetry revealed that mucosal tissue blood flow of the erosive lesion was elevated. The 24-hour pH monitoring showed pH was low in the gastric tube. The plasma gastrin level was just below the upper limit. The erosions were significantly improved and healed by the treatment with secretin in addition to PPI and H2RA.
The above results suggest that it is important to perform not only endoscopy, but also mucosal tissue blood flow measuring, pH monitoring and the plasma gastrin level examination.
