Bile reflux in postoperative alkaline reflux gastritis

Area of Science:

• Gastroenterology
• Surgical Gastroenterology
• Bile Acid Metabolism

Background:

• Postoperative alkaline reflux gastritis (PARG) is a complication following gastric surgery.
• Enterogastric reflux (EGR), the backflow of intestinal contents into the stomach, is implicated in PARG.
• Quantifying EGR is crucial for understanding and managing PARG symptoms.

Purpose of the Study:

• To evaluate enterogastric reflux (EGR) levels in patients with and without symptoms of postoperative alkaline reflux gastritis (PARG).
• To assess the impact of biliary diversion surgery on EGR levels in patients with symptomatic PARG.
• To determine the correlation between EGR levels and PARG symptom severity.

Main Methods:

• Quantification of bile acids (BA) in gastric juice using thin-layer chromatography and spectrofluorometry.
• Comparison of mean BA concentrations between control subjects, asymptomatic patients, and symptomatic PARG patients.
• Evaluation of EGR levels before and after Roux-en-Y biliary diversion in patients with PARG.

Main Results:

• Mean BA concentrations were significantly higher in symptomatic PARG patients (125.79 mumol/hour) compared to asymptomatic patients (47.94 mumol/hour) and controls (2.25 mumol/hour).
• Biliary diversion via Roux-en-Y anastomosis led to a significant reduction in EGR in 13 out of 15 treated patients.
• Symptomatic patients with high preoperative EGR levels ( > 80 mumol BA reflux/hour) showed clear benefits from biliary diversion.

Conclusions:

• Enterogastric reflux (EGR) is markedly increased in patients experiencing symptoms of postoperative alkaline reflux gastritis (PARG).
• Biliary diversion is an effective treatment for reducing EGR and managing symptoms in selected PARG patients.
• High EGR levels predict a positive response to surgical intervention for PARG.