Primary bile reflux gastritis: diagnosis and surgical treatment

Bile reflux gastritis has been recognized since the first successful gastric operations and has persisted for more than a century. Diagnosis has been difficult and non-operative therapy largely ineffective. Early attempts at surgical correction resulted in stomal ulceration and it was not until the advent of flexible endoscopy and other techniques that diagnosis became more secure. Operative attempts at correction have included the Roux-en-Y procedure, the Braun enteroenterostomy, and Henley jejunal interposition. None of the procedures has been uniformly successful, and the Roux-en-Y has resulted in a disabling stasis syndrome in most patients. The diagnosis of bile reflux without previous gastric surgery has been even more elusive and seems to be associated with previous cholecystectomy. Thirty-one patients diagnosed with primary bile reflux, having typical symptoms of epigastric pain, nausea, and bilious vomiting have been treated by diverting bile flow through a Roux-en-Y choledochojejunostomy without accompanying gastric resection or vagotomy. There were no operative deaths and no long-term problems, such as anastomotic stricture. Two patients had self-limited bile leaks. Twenty-seven of the 31 patients (87%) have achieved complete relief of symptoms and have no gastrointestinal complaints. Serial gastric emptying has demonstrated no alteration in 9 of 12 patients who were normal before operation, and improvement in 12 of the 19 (63%) patients with abnormal preoperative studies.