[Duodenogastric reflux--a current evaluation]

Area of Science:

• Gastroenterology
• Experimental Pathology

Context:

• The role of duodenogastric reflux (DGR) in gastrointestinal pathology has been debated for 150 years, since Beaumont's observations.
• Experimental evidence confirms the cytotoxic effects of bile acids and lysolecithin, key components of DGR.
• The clinical relevance of DGR in conditions beyond stress ulcers is still under scrutiny.

Purpose:

• To review and discuss the current understanding of duodenogastric reflux's role in gastrointestinal diseases.
• To evaluate the evidence for DGR's pathogenetic involvement in stress ulcers, chronic ulcers, and reflux esophagitis.
• To explore the implications of DGR in post-gastrectomy patients and its effect on stomal ulceration.

Summary:

• While the cytotoxic mechanisms of bile acids and lysolecithin in DGR are established, their clinical impact is debated.
• DGR is implicated in stress ulcer formation and secondary alkaline reflux esophagitis, but its role in chronic ulcers and primary reflux esophagitis requires further elucidation.
• The deleterious effects of DGR in operated stomachs are discussed but not clinically proven, contrasting with the established role of intestinal-gastric reflux in preventing stomal ulcers after gastrectomy.

Impact:

• Highlights the ongoing need for clinical research to clarify the precise role of DGR in various gastrointestinal disorders.
• Underscores the distinction between experimental findings and clinical evidence regarding DGR's pathogenicity.
• Provides a comprehensive overview for clinicians and researchers investigating upper gastrointestinal pathophysiology and surgical outcomes.