Duodeno-gastric Reflux and Gastric Adenomas: A Scintigraphic Study in Patients with Familial Adenomatous Polyposis

Abstract

SummaryTo test whether the presence of gastric adenomas (dysplasia) was associated with gastric reflux of duodenal contents, six patients with familial adenomatous polyposis (FAP) who had gastric adenomas and nine matched FAP patients without gastric adenomas underwent scintigraphic duodeno-gastric reflux scanning. Reflux was graded 0-6, where O=no reflux, l=intermittent reflux into antrum only, 2=prolonged reflux into antrum only, 3=intermittent reflux into body, 4=prolonged reflux into body, 5=intermittent reflux into body and fundus, and 6=prolonged reflux into body and fundus. FAP patients with gastric adenomas had more severe reflux (median 6, range 4-6) than did controls (median 3, range 0-6; P=0.009, Mann-Whitney U test). These results are consistent with a role for bile in the development of gastric adenomatous polyps and suggest that bile is involved in the dysplasiacarcinoma sequence.

Sulindac for periampullary polyps in FAP patients

“…Although pancreatico-duodenectomy (Whipple operation) would presumably be an effective preventive treatment, it is a major procedure with significant potential morbidity. Furthermore, following a Whipple procedure, bile would likely continue to have a deleterious effect on the jejunum at the choledojejunal anastomosis since bile may be a promoting factor for the development of adenomatous duodenal polyps [21][22][23][24].…”

Surveillance and management of upper gastrointestinal disease in Familial Adenomatous Polyposis

“…The distribution of foregut adenomas in FAP mirrors mucosal exposure to bile, suggesting a role for bile in the pathogenesis of these lesions. Support for this hypothesis comes from studies that have shown an excess of DNA adducts -chemical modifications of DNA implicated in the initiation of carcinogenesis [54] in the duodenum of FAP patients [55,56], along with scintigraphic studies, which have demonstrated that adenoma distribution mirrors bile reflux in FAP [57].…”

Application of the Intramolecular Isomerisation–Aldolisation from Allylic Alcohols and Allylic Silyl Ethers to the Synthesis of Indanones and Indenones

“…Pancreatic endocrine insufficiency requiring exogenous insulin therapy is a complication in at least 3–6 per cent, whereas exocrine insufficiency is observed in 30–60 per cent of patients39. A pancreaticogastric anastomosis with preservation of the pylorus should be considered in FAP; preservation of the pylorus decreases biliary reflux into the stomach, which is thought to be a risk factor in the development of gastric polyps in patients with FAP40, 41. Any residual duodenum must be monitored for polyps40, 42.…”

“…A pancreaticogastric anastomosis with preservation of the pylorus should be considered in FAP; preservation of the pylorus decreases biliary reflux into the stomach, which is thought to be a risk factor in the development of gastric polyps in patients with FAP40, 41. Any residual duodenum must be monitored for polyps40, 42. An anatomically correct reconstruction is the goal, both to facilitate surveillance and to maximize the length of functioning small bowel in patients who may have undergone restorative proctocolectomy previously35.…”