Bremner supported his early hypothesis that bile reflux may be related to Barrett's ulceration by reports of increased bile acids in the stomachs of some Barrett's patients and later, in the gastric juice of Barrett's patients with stricture. An increase in gastric bile salts in patients with reflux esophagitis and strictures has also been reported. Cowen reported on 42 patients with hypochlorhydria who had prominent gastric bile pool on endoscopy and histological evidence of gastritis, as well as esophagitis with heartburn unrelieved by antacids. Many studies have shown that duodenal contents can reflux through the stomach and into the esophagus. We have recently found that there was a close relationship between esophageal injury and increased esophageal exposure to pH 7, suggesting that alkaline components of refluxed gastric juice contribute to esophageal injury in humans. A similar process is thought to occur in humans,Īlthough it remains to be shown which specific components of the refluxed juice are important. Experimental animal models have shown that bile and various enzymes can cause significant esophageal injury. There is growing evidence that a similar process is involved in the columnar lined esophagus. Reflux of duodenal contents has long been suspected to cause gastric mucosal injury and has been causally implicated in the development of gastric carcinoma. Complications such as ulceration, stricture, dysplasia and carcinoma that can occur in the metaplastic Barrett's mucosa are likely, due to the composition of the refluxed material. In effect, the columnar change is an attempt to protect the esophagus from further acid injury. Evidence of this is seen at endoscopy where erosive esophagitis occurs in the squamous epithelium above a quiescent Barrett's lining. This appears to occur because the columnar cells are more resistant to acid. DeMeester (Los Angeles)Ĭontinued erosion of the lower esophageal mucosa by gastroesophageal reflux can result in replacement of the squamous epithelium with columnar cells. Intrinsic factor is secreted by parietal cells and is necessary for your body to absorb vitamin B-12. This is essential for healthy nervous system function and blood cell production.įinally, the gastric juice or juices contain water and mucus. Mucus is secreted by neck cells and helps coat and protect the stomach lining from the acidic environment.What is the effect of gastric juice on Barrett's mucosa? Gastric lipase is another digestive enzyme produced by major cells. Helps break down short and medium chain fats.Īmylase is also found in gastric juices, but it is not produced by the stomach. This enzyme comes from saliva and travels along with the bolus to the stomach.Īmylase breaks down carbohydrates, but it doesn’t take long to work in the stomach because the acidity stops it. But that’s okay, your small intestine produces more amylase later on. Pepsinogen is secreted by the main cells, and when it is in the presence of hydrochloric acid, it is converted to pepsin. Pepsin breaks down tertiary and secondary protein structures to facilitate the further work of digestive enzymes in the small intestine. Hydrochloric acid converts pepsinogen to pepsin and breaks down various nutrients apart from the food you eat. It also kills bacteria that come along with your food.