Alkaline Reflux Gastritis after Partial Gastrectomy: Evidence for a Pathogenetic Role of Deoxycholic Acid

Abstract

30 subjects submitted to Billroth II resection for duodenal ulcer were divided in two groups: 15 patients with severe remnant gastritis at endoscopic examination confirmed by histology and 15 control subjects. Total concentrations of bile acids in gastric remnant and bile acid pattern were determined in all subjects. In 15 patients (8 controls and 7 with severe remnant gastritis) a scintigraphy with ^99mTc-HIDA to estimate enterogastric reflux with subsequent gastric evacuation of refluxate was performed. Fasting bile acid reflux rate, enterogastric reflux and gastric evacuation of refluxate from the remnant proved to be similar in the two groups. In contrast the qualitative analysis of biliary reflux showed an increase in the amount of deoxycholic acid in patients with severe remnant gastritis (p < 0.05), compared with controls; no differences have been observed as for the amount of other bile acids and taurine and glycine conjugates. Therefore the increase in deoxycholic acid, probably due to bacterial overgrowth reported after gastric surgery, may contribute to develop and maintain gastritis after Billroth II anastomosis. Our findings also support the hypothesis that deoxycholic acid – recently postulated to promote colonic carcinogenesis -may play a role in the increased prevalence of cancer observed in the gastric remnant after gastric surgery.