Parietal cells in the oesophagus?

[chrisrob]

Perhaps I should wait until I see my surgeon in September but wonder if anyone can tell me.

I haven't had an oesophagectomy but had a Collis-Nissen fundoplication (repair) a few months ago.

The Collis procedure effectively extends the length of the oesophagus by using a wedge section of the stomach - in much the same way as the stomach is used to form the oesophagus in an Ivor Lewis.

The stomach is lined with parietal cells that produce acid. So I guess following an Ivor Lewis or a Collis, there are then acid producing cells actually within the oesophagus?

[chris_usa]

I guess that you could consider there to be parietal cells within the far lower part of your functional esophagus, however there are no cell changes (parietal cells in what was previously normal esophageal tissue) like those that you would see in Barrett's esophagus. In a Collis-Nissen, a part of your stomach is used as an extender of the esophagus so that an effective wrap may be completed. In my opinion, the biggest difference between your surgery and an esophagectomy is that there is no pull-up of the stomach into the chest. All of your parietal cells should still be happily pumping out acid below the level of the diaphragm, and your surgeon should have corrected any hiatal hernia that was present. Routine monitoring will probably still be performed, as it is likely that acid damage caused the need for the Collis. Hope this helped a little.

[Hidden]

This is definitely beyond my knowledge (I can imagine a lecturer at medical school musing - 'Ah That's an interesting one!'). So I passed your query on, and asked somebody who is definitely medically qualified in this area. I also whether any alteration to the nerve system would stop the parietal cells themselves from producing acid. My guess is that you are thinking about long term issues about continued exposure to acid in relation to Barrett's Oesophagus. My own non-qualifed understanding is that after an oesophagectomy there is still a theoretical prospect of further Barrett’s development in any remains of the oesophagus if the acid supply is still an issue.

So this is his reply, which I hope is helpful, and you should treat it with greater respect than mine!

I am sure this is one of your more interesting and difficult queries!

Indeed, both the Ivor Lewis and the Collis-Nissen result in parietal cells in the neo-oesophagus. This is not the same as acid producing cells in the oesophagus as stated by your questioner. Not necessarily acid –producing for the reason you state ie they have been denervated. Not in the oesophagus, since they remain in their natural habitat, albeit now above the diaphragm. In practice, the development of high grade dysplasia or another oesopahegal adenocarcinoma after Ivor Lewis is exceedingly rare; a Collis-Nissen has the added advantage of having (hopefully) a competent anti-reflux mechanism, unlike the Ivor Lewis and the procedure would have been discontinued long ago if the possible theoretical risk had translated into a practical one.