The use of an instillation test to define alkaline reflux gastritis

Alkaline reflux gastritis following gastric surgery is an ill-defined syndrome characterised by epigastric pain, bile vomiting and weight loss. Endoscopy and gastric histology do not confirm the diagnosis. It appears that duodenal contents refluxing into the stomach are the cause of this entity. In an effort to quantify this attempts have been made to quantitate the reflux. Techniques include measuring bile acids in fasting gastric aspirates and, more recently, Tc HIDA scanning. Tolin et al showed a good correlation between the enterogastric reflux index and patients with symptoms of alkaline reflux gastritis. Recent work has suggested that HIDA reflux is difficult to quantitate. Recently Meshkinpour et al induced the symptoms of alkaline reflux gastritis by infusing endogenous duodenal juice onto the gastric mucosa. This paper confirms those findings and uses the technique to improve patient selection for Roux-en-Y diversion.