Comparison of antacids on the binding of bile salts

Following a gastric operation (and occasionally in other patients), biliary reflux may damage the stomach mucosa. If severe damage occurs, a diverting Roux-en-Y procedure may be required. In most cases, nonoperative treatment is successful. Since bile salts have been implicated as a cause of mucosal injury, we evaluated the efficacy of antacids in binding these salts. Several bile salts were mixed with certain antacids and with cholestyramine resin, and the adsorption was determined. Cholestyramine resin absorbed 90% to 97% of the bile salts. At a pH of 7, magaldrate (Riopan) absorbed the dihydroxy-bile salts as well as cholestyramine resin, but the other antacids we tested showed poor adsorption. The ability of antacids to bind bile salts must be considered when treating bile salt-induced injury with these substances.