The effect of cholecystectomy on duodenogastric reflux in patients with previous peptic ulcer surgery

Duodenogastric reflux (DGR) has been assessed in healthy volunteers, patients after vagotomy and pyloroplasty, and in patients following vagotomy and pyloroplasty in addition to cholecystectomy. DGR has been assessed using bilirubin output and 99mTc EHIDA recovered in gastric juice. The control group demonstrated reflux but the quantity was small. Symptomatic patients after truncal vagotomy and pyloroplasty (V + P) showed a significant increase in DGR (P less than 0.002) when compared with the control group but the greatest reflux was seen in symptomatic patients following truncal vagotomy + pyloroplasty + cholecystectomy (P less than 0.002). AS with pyloric preservation showed no significant increase in reflux but the addition of cholecystectomy increased both frequency (P less than 0.001) and amount of reflux (P less than 0.001). We suggest that cholecystectomy when combined with a pylorus preserving or destroying procedure increases DGR and that such increased reflux may be an important factor in gastritis following peptic ulcer surgery.