Pre- and Postcholecystectomy Duodenogastric Reflux

Abstract

The purpose of the study was to assess whether cholecystectomy is usually followed by increased duodenogastric reflux and whether there are subsequent changes in the histology of the gastric mucosa and in acid secretion. Eleven patients were submitted, before cholecystectomy and 6 months afterwards, to gastric aspirates, assay of bile acids in the gastric juice and gastroscopy with biopsies from the antral mucosa and the main body. Our results show a significant increase, after cholecystectomy, in the amount of duodenogastric reflux (p < 0.01). However, the total amount of bile acids present in the stomach do not seem to affect the inflammatory injury to the mucosa. Nine times out of eleven there was a reduction of maximal gastric acid output: again, this fact does not seem to be correlated to the amount of bile reflux. The authors conclude that, as already stressed by others, injury to the mucosa is less affected by the amount of bile acids flowing back into the stomach than by other important factors such as the duration of contact, gastric pH, the presence of other constituents in the duodenal juice (lysolecithin) and the type of bile acid that is actually present.