Effect of duodenogastric reflux on gastric mucosal proliferation after gastric surgery

Houghton, P. W.; Mortensen, N. J. McC.; Williamson, R. C. N.

doi:10.1002/bjs.1800740421

Cited by 24 publications

(13 citation statements)

References 22 publications

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“…It was proved (2, 7, 11) that a BII-type distal gastroenterostomy increases the risk of stomach cancer, while the smallest changes occur after Roux-en-Y gastric bypass surgery, considered by some as an anti-reflux procedure. Inflammatory changes (2,11,14) are most common in areas adjacent to those influenced by surgical procedures. Such areas may also become malignant after long-term influence of refluxed bile (6,13).…”

Section: Discussionmentioning

confidence: 99%

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Morphological Changes in the Stomach Mucosa of Rats Caused by Endogenous Bile Acids

Rudnicki¹,

Мазур

Slusarczyk

et al. 2007

Polish Journal of Surgery

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"Bile reflux" is a common term to denote a process of placing duodenal contents in the stomach and/or lower oesophagus. It is most often associated with functional or organic failure of the pylorus and is a not uncommon postoperative condition after pyloric section, resection or by-passing. Gastrotoxicity of the replaced small intestinal mixture leading to lesions in gastric mucosal barrier, is caused by an increased ability to reabsorb hydrogen ions along with migration of blood proteins and electrolytes towards lumen of the stomach. Consequently, histamine secretion becomes increased, leading to inflammatory and haemorrhagic changes or ulcer niches. The aim of the study was to demonstrate histological and microscopic changes in the gastric mucosa following reflux and to determine if long-term exposure to refluxed duodenal contents will produce tumorous changes in the organs tested. Material and methods. The study consisted of 25 mature female Wistar rats weighing 180-200 g. Bile reflux to the stomach was produced experimentally by surgical drainage. Final evaluation was performed after 55 weeks. Results. Findings were as follows: gastric changes were noted in basal and parietal cells, no tumorous foci were found in histological samples. Slight morphological changes can be caused by short periods of gastric mucosa exposure to the gastrotoxic small intestinal mixture. Conclusions. Endogenous bile acids cause morphological changes in the stomach mucosa of rats. In particular, these changes affect the ultrastructure of basal and parietal cells. No neoplastic foci were found in the examined organs.

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Section: Discussionmentioning

confidence: 99%

“…These procedures can lead to inflammatory lesions of the mucosa, atrophic and inflammatory changes, and cellular metaplasia (1)(2)(3)(4)(5). Some sources even consider these changes to be premalignant lesions (6,7).…”

mentioning

confidence: 99%

Morphological Changes in the Stomach Mucosa of Rats Caused by Endogenous Bile Acids

Rudnicki¹,

Мазур

Slusarczyk

et al. 2007

Polish Journal of Surgery

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“…Gastric resection models simulate the existing techniques in surgical clinic (Billroth I or II), accompanied or not by truncal vagotomy 3,4,17,18 .…”

Section: Discussionmentioning

confidence: 99%

“…Several investigations were carried out to clarify whether patients undergoing surgery with techniques that promote duodenogastric reflux, such as partial gastrectomies in case of benign disorders, would be at higher risk than the non-gastrectomized population for development of cancer of the remaining gastric stump 3,4,5 . Since the start of the 80s decade, by means of wellconducted research, it has been definitively established that patients submitted to techniques that promote duodenogastric reflux, such as Billroth II reconstruction, are more susceptible to neoplasia after a postoperative period longer than 20 years 6,7,8,9 .…”

Section: Introductionmentioning

confidence: 99%

Gastric proliferative lesions induced by duodenogastric reflux in rats

et al. 2006

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Purpose: To analyze mucosal proliferation and its characteristics, through specific models of duodenogastric reflux, in the stomach of Wistar rats. Methods: Seventy-five healthy and adult male rats were divided into three groups: group Icontrol (n = 25 animals), submitted to gastrotomy of the posterior wall of the glandular stomach; group II -DGR (n = 25 animals), submitted to duodenogastric reflux through latero-lateral gastrojejunal anastomosis in the posterior wall of the glandular stomach and group III -DGR-P (n = 25 animals), submitted to duodenogastric reflux through the pylorus following the same procedure of group II, sectioning and closing the afferent loop. The animals were observed during 36 weeks and subsequently the mucosal lesions were analyzed, with macroscopic and microscopic examination of the prepyloric, the gastrojejunostomy and the squamous area of the stomach. Results: Group I did not present any kind of lesion. Macroscopic lesions of the prepyloric area in groups II and III were 0% and 20%, respectively. Macroscopic lesions of the gastrojejunal stoma in groups II and III were 36% and 88%, respectively, and 12% and 28%, respectively, in the squamous area. Microscopically, adenomatous hyperplasia (AH), squamous hyperplasia (SH) and adenocarcinoma (AC) were diagnosed. The occurrence of AH at the prepyloric area in groups II and III was 0% and 40%, respectively, and in the gastrojejunal stoma, 40% and 72%, respectively. The occurrence of SH in the squamous area in groups II and III was 12% and 20%, respectively, without statistical differences between the groups. AC was found only in three animals of groups III (12%). Conclusions: The duodenogastric reflux in this experimental model caused high frequency of proliferative lesions of the gastrojejunal stoma and in the prepyloric area, while adenocarcinoma was a rare occurrence. Key words: Duodenogastric Reflux. Hyperplasia. Adenocarcinoma. Rats. RESUMOObjetivo: Avaliar as lesões proliferativas que se desenvolvem na mucosa gástrica de ratos Wistar após modelo específico de refluxo duodeno-gástrico. Métodos: Foram utilizados 75 ratos adultos machos divididos em três grupos experimentais: o grupo I (controle) submetido a gastrotomia na parede posterior do estômago glandular (25 animais); o grupo II (RDG), foi submetido a gastrojejunoanastomose látero-lateral na parede posterior do estômago glandular (25 animais) e o grupo III (RDG-P) submetido a gastrojejunoanastomose látero-lateral na parede posterior do estômago glandular, com secção e fechamento da alça (25 animais). Os animais foram observados durante 36 semanas, após o que foram realizados estudos macroscópicos e microscópicos da anastomose gastrojejunal, da região pré-pilórica e região escamosa do estômago. Resultados: Os animais do Grupo I não apresentaram nenhum tipo de lesão. No grupo II observou-se 40% de lesões do tipo hiperplasia adenomatosa na anastomose e 12% de hiperplasia escamosa. No grupo III obteve-se 40% de hiperplasia adenomatosa na mucosa pré-pilórica, 72 % de hiperplas...

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“…He concluded that bile was not responsible, but in this study bile acids were nonetheless detectable in the stomach in the alleged bilefree group, perhaps because of the short distance (10 ern) which separated the implanted bile duct and the gastro-enteric anastomosis. Houghton et al 9 also performed several reflux-inducing operations on rat~,…”

Section: Discussionmentioning

confidence: 99%

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

1991

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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.

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Effect of duodenogastric reflux on gastric mucosal proliferation after gastric surgery

Cited by 24 publications

References 22 publications

Morphological Changes in the Stomach Mucosa of Rats Caused by Endogenous Bile Acids

Morphological Changes in the Stomach Mucosa of Rats Caused by Endogenous Bile Acids

Gastric proliferative lesions induced by duodenogastric reflux in rats

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

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