[Reflux and reflux disease following gastric resection (author's transl)]

Intragastric concentrations of lysolecithin and bile acids were determined in 112 patients with different types of gastrectomy for peptic ulcer (Billroth I and Billroth II). These values were correlated with intragastric pH, bacterial contamination, gastric mucosal changes and Visick grading. A maximal amount of duodenogastric reflux was found in retrocolic gastrojejunostomy (Billroth II). Smaller, but still highly pathological values were observed in the antecolic gastrojejunostomy with Braun enteroanastomosis as well as in different types of gastroduodenostomy (Billroth I). 70% of the operated stomachs were bacterially contaminated. There was a good correlation between amount of reflux, bacterial contamination and pH-value. Above pH 6 no stomach was sterile, the lysolecithin-concentration increased more than proportional. Gastric mucosal changes correlated closely with the intragastric lysolecithin concentration and the bacterial contamination. There was no correlation between amount of reflux and Visick-grading, no complaints were found in some cases with extreme reflux values as vice versa. The postoperative alkaline reflux gastritis is described, the consequences including the carcinoma of the gastric stump are mentioned. The principles of ulcer surgery are analysed under these aspects.