Mechanisms underlying duodeno‐gastric reflux in man

Koek, Ger H.; Vos, Rita De; Sifrim, Daniel; Cuomo, Rosario; Janssens, Jozef; Tack, Jan

doi:10.1111/j.1365-2982.2004.00633.x

Cited by 43 publications

(19 citation statements)

References 26 publications

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“…Given the high exposure to DGR, the question arises about the mechanisms underlying DGR. Alterations in gastric emptying and antroduodenal malfunction are known to affect DGR [15]. Recirculating fluids in patients with GERD may further enhance the amount of DGR.…”

Section: Discussionmentioning

confidence: 99%

Effect of Cholecystectomy on Gastric and Esophageal Bile Reflux in Patients with Upper Gastrointestinal Symptoms

et al. 2007

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Epidemiologic data have shown that cholecystectomy is associated with a moderately increased risk of esophageal adenocarcinoma. The study objective was to evaluate the role of refluxed bile. A total of 696 patients with upper gastrointestinal symptoms were included in the study, of whom 55 had a history of cholecystectomy (CHE). Bilirubin exposure was measured in percent time above absorbance 0.25 in the stomach and above 0.14 in the esophagus. Total gastric and esophageal bilirubin exposure was similar in both groups. Supine gastric bile reflux was slightly increased after cholecystectomy (30.6 +/- 30.2 vs. CHE: 37.1 +/- 29.5, P < 0.05). In patients with erosive esophagitis or Barrett's esophagus, there were differences in total gastric exposure (24.3 +/- 22.6 vs. CHE: 36.7 +/- 26.8, P < 0.05) but not in esophageal exposure. Cholecystectomy slightly augments bile reflux into the stomach without detectable differences in the esophagus. Therefore, increased esophageal bile reflux following cholecystectomy as a potential cause for the associated cancer risk could not be substantiated.

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Section: Discussionmentioning

confidence: 99%

Effect of Cholecystectomy on Gastric and Esophageal Bile Reflux in Patients with Upper Gastrointestinal Symptoms

et al. 2007

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“…Reflux of duodenal contents into the stomach is a physiological phenomenon, which occurs in health after a meal [120]. However, an excessive amount of reflux of duodenal contents to the stomach may be pathological.…”

Section: Duodenal Gastroesophageal Refluxmentioning

confidence: 99%

The Spectrum of Motor Function Abnormalities in Gastroesophageal Reflux Disease and Barrett’s Esophagus

et al. 2009

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Barrett’s esophagus has traditionally been regarded as the most severe end of the spectrum of gastroesophageal reflux disease and is of great clinical importance in view of the association with esophageal adenocarcinoma. Studies have documented high levels of esophageal acid exposure in Barrett’s esophagus. Various pathogenetic mechanisms underlie this phenomenon. These include abnormalities in esophageal peristalsis, defective lower esophageal sphincter pressures, gastric dysmotility and bile reflux. Whilst these factors provide evidence for an acquired cause of Barrett’s esophagus, an underlying genetic predisposition cannot be ruled out. Although the past decade has brought about many new discoveries in the pathogenesis of Barrett’s esophagus, it has also added further controversy to this complex disorder. A detailed analysis of the gastrointestinal motor abnormalities occurring in Barrett’s esophagus follows, with a review of the currently available literature and an update on this condition that continues to be of interest to the gastroenterologist.

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“…A limited quantity of bile also flows retrograde into the proximal duodenum to the region adjacent to the pylorus. The pyloric sphincter during life is a poor barrier to duodeno-gastric reflux, and reflux of duodenal contents into the stomach cavity is a normal phenomenon both following meals and in the fasting state (11). It can therefore be expected that either in the agonal phase or following death that small quantities of bile containing high concentrations of morphine could readily reflux from the duodenum into the stomach.…”

Section: Discussionmentioning

confidence: 99%

Morphine Concentrations in Stomach Contents of Intravenous Opioid Overdose Deaths

Duflou

Darke

Easson

2009

Journal of Forensic Sciences

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Death caused by heroin overdose is almost always the result of intravenous injection of the drug in Australia. We briefly describe a case where a heroin overdose was initially thought to be the result of oral ingestion of the drug, primarily as a result of higher concentrations of morphine in stomach contents than in blood. During the subsequent criminal trial and investigation, however, the issue of the entero-hepatic circulation of morphine was raised as a possible reason for the presence of morphine in the stomach contents. In this study, we report on the distribution of opioids in blood, stomach contents, urine, liver, and bile in 29 deaths caused by intravenous heroin overdose. The mean total and free blood morphine concentrations were 0.60 and 0.32 mg/L, respectively, and the mean stomach contents total morphine concentration was 1.16 mg/kg. All cases had detectable morphine in the stomach contents, and 24 of 29 cases (83%) had higher concentrations of total morphine in stomach contents than in blood. The mean total morphine concentration in bile was c. 100 times that in blood, and the liver total morphine concentration averaged twice that of blood levels. We conclude that the entero-hepatic circulation of morphine and subsequent reflux of duodenal contents back into the stomach can result in the deposition of morphine in gastric contents. Consequently, the relative levels of opioids in blood and stomach contents cannot be used to determine the site of administration of the drug.

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Mechanisms underlying duodeno‐gastric reflux in man

Cited by 43 publications

References 26 publications

Effect of Cholecystectomy on Gastric and Esophageal Bile Reflux in Patients with Upper Gastrointestinal Symptoms

Effect of Cholecystectomy on Gastric and Esophageal Bile Reflux in Patients with Upper Gastrointestinal Symptoms

The Spectrum of Motor Function Abnormalities in Gastroesophageal Reflux Disease and Barrett’s Esophagus

Morphine Concentrations in Stomach Contents of Intravenous Opioid Overdose Deaths

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