A case of perforated refractory ulcer in the gastric tube after esophageal cancer

A 66-year-old man who had undergone esophagectomy for intrathoracic esophageal cancer developed a peptic epithelial ulcer and edema on the anterior aspect of the reconstructed gastric tube while undergoing regular follow-up examinations. On admission, he received ulcer therapy, but the ulcer didn't heal and the gastric tube was partialy resectioned under local anesthesia. The ulcer recurred twice, and we conducted a thorough investigation. A detailed history revealed that he had been treated of the shoulder with NSAIDS and long-term steroid therapy, and they were thought to be factors contributing to formation of the ulcers. A secretin test was performed to rule out the Zollinger-Ellison syndrome, but it was negative because the patients' plasma gastrin level was continuously high (1,210-1,620pg/ml) and there was no paradoxical response. The plasma gastrin level was much higher than in other cases reported in Japan, and we attempted to find the cause. Parietal cell antibody (PCA) was negative. The patient was positive for urophanic and serum antibodies to Helicobacter pylori, but the gastric tube resection specimens were negative, and the cause remained unclear. Because of the generally long-term survival after esophageal cancer surgery, patient education is necessary to prevent the development of gastric tube ulcers.