Bile reflux gastritis and esophagitis

Area of Science:

• Gastroenterology
• Surgical Gastroenterology

Background:

• Bile reflux gastritis and esophagitis are common complications after gastric surgery.
• Symptoms include epigastric pain, heartburn, dysphagia, and hematemesis, often unresponsive to antacids.

Purpose of the Study:

• To review the diagnosis and treatment of bile reflux gastritis and esophagitis in patients with a history of peptic ulcer disease and gastric operations.
• To evaluate the effectiveness of surgical interventions, particularly Roux-en-Y diversion.

Main Methods:

• Retrospective review of 39 patients diagnosed with bile reflux gastritis and esophagitis.
• Endoscopic examination and biopsy for diagnosis.
• Analysis of treatment outcomes, including medical management and surgical interventions.

Main Results:

• All 39 patients presented with epigastric pain; other symptoms included heartburn (26), dysphagia (13), and hematemesis (7).
• Endoscopy confirmed bile reflux in all patients, with gastritis (39) and esophagitis (21).
• Roux-en-Y bile diversion was successful in 9 of 12 patients, with adequate efferent limb length (45 cm) being crucial.

Conclusions:

• Accurate diagnosis distinguishing bile reflux from other conditions is vital for successful management.
• Roux-en-Y diversion is an effective surgical option for refractory bile reflux gastritis and esophagitis.
• Optimizing surgical technique, specifically efferent limb length, improves outcomes.