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Enterogastric reflux of bile has been shown to be associated with chronic gastritis. We have investigated preoperative duodenal ulcer patients and patients treated by highly selective vagotomy, Polya partial gastrectomy, truncal vagotomy and pyloroplasty, and truncal vagotomy and gastrojejunostomy to assess the incidence of endoscopically observed bile reflux and gastritis, and to quantitate the degree of reflux of bile acids and histologically proven gastritis. The correlation between observed and proven gastritis was poor when the observed incidence of bile reflux was low (preoperative duodenal ulcer, highly selective vagotomy) but was good when the observed reflux was high (partial gastrectomy, truncal vagotomy, and drainage). Bile acid concentrations in the stomach were significantly lower after highly selective vagotomy than in preoperative patients and those treated by partial gastrectomy and truncal vagotomy and drainage. The antritis and body gastritis found before operation did not improve after highly selective vagotomy, but antritis showed a tendency to worsen after partial gastrectomy and truncal vagotomy and drainage. Body gastritis after highly selective vagotomy was significantly less (P < 0.001) than after partial gastrectomy and less than after truncal vagotomy and gastrojejunostomy and truncal vagotomy and pyloroplasty. The beneficial effects of highly selective vagotomy in the treatment of duodenal ulcer may be enhanced in the long term by reduction of enterogastric reflux and postoperative gastritis.

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