Bile Reflux in Postoperative Alkaline Reflux Gastritis

Abstract

This study evaluates enterogastric reflux (EGR) levels in patients with and without symptoms of postoperative alkaline reflux gastritis (PARG) after gastric surgery. The bile acids (BA) present in the gastric juice were quantified by thin-layer chromatography and spectrofluorometry. The mean BA concentration for controls was 2.25 mumol reflux/hour, for 15 asymptomatic patients 47.94 and for 15 patients with symptoms of PARG 125.79. After biliary diversion by a Roux-en-Y anastomosis in the latter, their BA in 13 of these patients after surgery, and relapsed in only one during a 4-year follow-up. The remaining two patients had the lowest preoperative BA levels in this group. These results indicate that EGR is increased after gastric surgery more markedly indicated that EGR is increased after gastric surgery more markedly in patients with symptoms of PARG, and that patients who have high levels of EGR (more than 80 mumol BA reflux/hour) clearly benefit from biliary diversion.

Relation of Gallbladder Function and <i>Helicobacter pylori</i> Infection to Gastric Mucosa Inflammation in Patients with Symptomatic Cholecystolithiasis

“…Apart from the established role of an increased duodenogastric reflux (DGR) in the clinical entity of postgastrectomy alkaline reflux gastritis [12,13,14,15], there is also evidence that an impaired function of the sphincter of Oddi could induce an increased DGR and gastritis [7]. In investigations regarding patients after cholecystectomy (CHE), an increased DGR was shown with scintigraphy, aspiration and analysis of gastric contents, 24-hour pH monitoring and the Bilitec device [7,16,17,18,19,20,21,22,23].…”

Alkaline Reflux Gastritis: Early and Late Results of Surgery

“…Diversion of intestinal contents from the gastric remnant is invariably successful at this length, and control of symptoms is achieved in up to 85% of patients. 6,7,11,14,17 This procedure also results in significant improvement of endoscopic findings. 18 Unfortunately, after Roux-en-Y gastrojejunostomy, normal foregut physiology is severely altered 19 ; absent or disordered migration of myoelectric complexes, diminished prograde propulsion, and ectopic pacemakers in the Roux limb, which often drive peristalsis orally, have been described in the Roux stasis syndrome.…”

Quality of life and impact of bile reflux after retro colic retro gastric gastrojejunostomy in Whipple surgery

“…Most data are from studies that used gastrectomy for distal gastric or duodenal cancer. In these studies, Roux en Y reconstruction was used to overcome bile reflux after distal gastrectomy [12, 13]. However, mobilizing a separate limb for biliary diversion adds more surgical time in addition to inherent problems of the Roux loop [14].…”