Bile reflux and degree of gastritis after highly selective vagotomy, truncal vagotomy, and partial gastrectomy for duodenal ulcer

Abstract

Enterogastric reflux of bile has been shown to be associated with chronic gastritis. We have investigated preoperative duodenal ulcer patients and patients treated by highly selective vagotomy, Polya partial gastrectomy, truncal vagotomy and pyloroplasty, and truncal vagotomy and gastrojejunostomy to assess the incidence of endoscopically observed bile reflux and gastritis, and to quantitate the degree of reflux of bile acids and histologically proven gastritis. The correlation between observed and proven gastritis was poor when the observed incidence of bile reflux was low (preoperative duodenal ulcer, highly selective vagotomy) but was good when the observed reflux was high (partial gastrectomy, truncal vagotomy, and drainage). Bile acid concentrations in the stomach were significantly lower after highly selective vagotomy than in preoperative patients and those treated by partial gastrectomy and truncal vagotomy and drainage. The antritis and body gastritis found before operation did not improve after highly selective vagotomy, but antritis showed a tendency to worsen after partial gastrectomy and truncal vagotomy and drainage. Body gastritis after highly selective vagotomy was significantly less (P < 0.001) than after partial gastrectomy and less than after truncal vagotomy and gastrojejunostomy and truncal vagotomy and pyloroplasty. The beneficial effects of highly selective vagotomy in the treatment of duodenal ulcer may be enhanced in the long term by reduction of enterogastric reflux and postoperative gastritis.

Reactive gastropathy is associated with inflammatory conditions throughout the gastrointestinal tract

“…[6][7][8][9] Between 1983 and 1986, Dixon's group in Liverpool published a series of papers in which they systematically described these changes and proposed 'bile reflux gastritis' as a distinct clinicopathological entity. [10][11][12][13] Shortly thereafter, it seemed clear that identical lesions were often found in the gastric mucosa of patients who regularly used nonsteroidal anti-inflammatory drugs (NSAIDs), and the broader term 'chemical gastritis' was introduced and recommended by the Updated Sydney System. 14 An update of the criteria for the differential histopathological diagnosis of this condition was published in 2005.…”

Spontaneous Bile Reflux in the Elderly

“…Gastric juice contamination by bile acids has been implicated in the pathogenesis of gastritis [1,2], peptic ulcer [3,4] and reflux oesophagitis [5], Duodenogastric bile reflux may also promote carcinogenesis in the stom ach [6], A distinctive histological picture has been recognised in biopsy specimens taken from postoperative stomachs since the early 1980s [7,8]. It is characterised by foveolar elongation and tortuosity, together with oede-ma, vasodilatation, paucity of inflammatory cells and the presence of smooth muscle cells in the lamina propria [9].…”

A Deep Learning Convolutional Neural Network Can Recognize Common Patterns of Injury in Gastric Pathology

“…[31][32][33][34][35][36][37][38][39] The other classic and common pattern of injury investigated in this study is reactive gastropathy. Reactive gastropathy is typically antral predominant, associated with duodenopancreatic (bile) reflux, 40,41 and various medication/ chemical agents, including nonsteroidal anti-inflammatory drugs, acid, alkali, and ethanol. [42][43][44] Given that millions of people worldwide ingest nonsteroidal anti-inflammatory drugs and ethanol daily, reactive gastropathy is one of the most common diagnoses of gastric biopsies in industrialized countries.…”