Spontaneous EnterogastricReflux Gastritis and Esophagitis

Abstract

Enterogastric reflux gastritis and esophagitis is best known after gastric resections and pyloroplasty but it also occurs spontaneously in the nonoperated patient. Forty-two patients are presented who meet the criteria for the diagnosis: constant burning epigastric pain, worse after meals, unrelieved by antacids and diet; endoscopic demonstration of a gastric bile pool; endoscopic biopsy proof of gastritis and esophagitis; and hypochlorhydria. Patients with mild and moderate stages of the disease can benefit from metoclopramide therapy which improves the gastric emptying mechanism. Of the surgical patients with intractable symptoms, 90% were women, 90% had marked hypochlorhydria, 83% had biliary disease, current or remote, and 50% had anemia. With vagotomy, antrectomy, and Roux-Y anastomosis 45-60 cm downstream, the clinical response has been most encouraging.

Central Nervous System Plus Autonomic Nervous System Disorders Responsible for Gastrointestinal and Pancreatobiliary Diseases

“…This iatrogenic phenomenon is more evident in cholecystectomized patients, because bilis is not stored in the gallbladder. Accordingly, we believe that an adequate neuropharmacological therapy is the only therapeutical strategy able to revert the above-mentioned iatrogenic deleterious pathophysiologic disorders [4,33,[63][64][65][66][67][68][69][70].…”

Effects of Profound Duodenogastric Reflux on the Foregut in Rats

“…23]. Excessive DGR has been seen after gastric sur gery [24,25] and cholecystectomy [26,27], but also occurs without prior foregut surgery [4,5,28], In man, DGR has been implicated as a contributing factor in the pathogene sis of a variety of foregut diseases including gastric and duodenal ulcers [ 1 ], esophagitis [5,7] and Barrett's esoph agus [29]. Moreover, it has been suggested that DGR may induce premalignant changes in the gastric and esophage al mucosa [3,8] and DGR has been implicated as a cause of gastric stump cancer [2,3], In rats, reflux of pancraticoduodenal secretions, but not bile, causes adenocarcinoma of the stomach [2] and enhances the effect of carcinogens in the esophagus [8], It has previously been shown that the split gastrojejunostomy causes a rise in plasma CCK and gastrin and produces pancreatic growth in rats [10,11], Furthermore, long-term profound DGR in rats has been shown to produce pancreatic tumors [9], The mechanism responsible for the pancreatic growth is of interest since epidemiological studies in humans have suggested pre vious gastric surgery as a risk factor for pancreatic cancer [14][15][16], Thus DGR contributes to a variety of gastroin testinal diseases through mechanisms which have as yet not been identified.…”

In Vitro Effects of Rabeprazole on Human Pylorus Tone

“…In previous in vivo studies, it has been shown that physiological gastroduodenal flow and duodenogastric reflux occurs in a sequence and duodenogastric reflux occurs just before pyloric closure following gastroduodenal flow. [8][9][10] Thus, the suspected cause of duodenogastric reflux or delayed gastric emptying is discoordination between pyloric and antral motor activities. 8,[11][12][13] Hence, any factor, which could interfere the cyclic contractions of the pylorus and antrum, may increase the reflux or slow down gastric emptying.…”

“…8,[11][12][13] Hence, any factor, which could interfere the cyclic contractions of the pylorus and antrum, may increase the reflux or slow down gastric emptying. [8][9][10] The previous studies on gastroduodenal flow have suggested that PPIs not only decrease acid but also bile reflux, owing to its antisecretory effects. [14][15][16][17][18] In the present study, we aimed to reveal the in vitro effects of PPIs on the contraction of human pylorus muscle, independent from anti-acid and antisecretory effects.…”