[Alkaline reflux after gastric resection using the Billroth II method]

Among the more indicative complications encountered in gastrectomized patients, particularly in those cases where the Billroth II technique is used, bile and/or pancreatic reflux is undoubtedly one of the most important manifestations. The abolition of the "sphincteric" function of the pylorus creates a pathophysiological condition of the above-mentioned type when the surgery is not combined with specific antireflux techniques or when particular situations obtain which make alkaline reflux inevitable. These pathophysiological disorders lead to a "chronic gastritis of the stump", which often exhibits differing symptomatic pictures. There are patients in whom there is no correspondence between the anatomo-pathological and symptomatic pictures and who do not suffer at all, phereas there are others (5-35%) who complain of severe symptoms such as epigastric pain aggravated by ingestion of food, reduction in weight, nausea, bile vomiting and often haemorrhagic stillicide with consequent sideropaenic hypochromic anaemia. Taking the above-mentioned considerations as their starting point, the authors set out to investigate these complications more thoroughly in the pathology of gastrectomized patients by means of the long-term follow-up of such patients coming to them for observation after having been subjected to surgical therapy in the form of Billroth II gastric resection (gastro-enterostomy according to Balfour-Kroenlein, or according to Hofmeister-Fininsterer). The study, which is currently still in progress, involves a thorough clinical examination of the symptoms complained of as well as radiological, gastroscopic, histological and haematochemical investigations. The authors report on their preliminary results.