The Effect of Bile Reflux on the Gastric Mucosa

Sander, S.; Myren, J; Helsingen, N

doi:10.1159/000202278

Cited by 15 publications

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“…However, with continuous exposure to bile, the mucosa apparently develops adaptive mechanisms that lead it to revert to normal. The same phenomenon was described by Byers and Jordan [12] and Sander et al [16] in different experimental models. On the other hand, Delaney et al [13] reported that mucosal changes induced by bile did not progress with time, gastritis lesions being as severe at 4 months as at 24 months after surgery.…”

Section: Discussionsupporting

confidence: 83%

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Long‐term effects of bile on the gastric mucosa of the dog

Oliveira

Azevedo

1980

World j. surg.

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Bile was allowed to act on the gastric mueosa of dogs for periods of time ranging from 60 to 540 days. Then the mucosa was studied by light microscopy and morphometric techniques to determine height of the mucosa, infundihulum and glands, number of mast cells, and number of interepithelial lymphocytes. Marked acute inflammatory lesions and decrease in cellular mucin content were observed mainly in the antral mucosa exposed to bile for up to 130 days. Other changes appearing both in the antrum and fundus of the same dogs included an increase in the number of interepithelial lymphocytes, architectural distortion, and decrease in the height of the mucosa, the infundibulum being the most affected component in the antrum and the glands in the fundus. Positive alkaline phosphatase activity was observed in the antral area up to 130 days. With continuous exposure to bile, the gastric mucosa appeared to undergo adaptation, since all the described alterations gradually disappeared.Gastric ulcers are believed to result from decreased resistance to various aggressive factors [1][2][3][4][5][6][7][8]. Biliary reflux has been proposed as a possible etiologic factor in gastric ulcer. We have previously described some of the acute effects of bile on the gastric mucosa of the dog [9]. In the present studies, we performed a quantitative analysis of the long-term effects of bile on the gastric mucosa of the dog. The aim of this study was to find out if there is any similarity between the long-term effects of bile on the gastric mucosa and the lesions of naturally occurring gastric ulcer. 471 Materials and MethodsThirty-six mongrel dogs of both sexes, weighting 9-20 kg and fasted for 24 hours were allocated into 6 groups, according to the duration of the cholecystographic anastomosis: A--60 days, n = 6; B--90 days, n = 5; C--130 days, n = 6; D--365 days, n = 5; E--540 days, n = 5; and F--9 control dogs without a cholecystogastrostomy. The dogs were anesthetized with sodium pentobarbital (30 mg/kg, intravenously) and through a median laparotomy, the terminal end of the common bile duct was ligated and an anastomosis was established between the fundus of the gallbladder and the antrum-fundus junction of the stomach. The animals received a liquid diet during the first 24 hours after surgery and gradually resumed a normal diet. The cholecystogastrostomy was maintained for variable periods of time, namely, 60, 90, 130, 365, and 540 days. At the end of these periods of time, a median laparotomy was performed under anesthesia, and the ligation of the bile duct and patency of the anastomosis were verified. The stomach was excised, opened along the greater curvature, examined macroscopically, and then fixed in Bouin solution for 24 hours.Samples from the antral, fundic, and perianastomotic mucosa were collected and processed. Microscopic sections were stained with hematoxylin-eosin, PAS, and toluidine blue [10]. Alkaline phosphatase was identified histochemically by the Gomori technique.Mast cells and interepithelial lymphocytes were counte...

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Section: Discussionsupporting

confidence: 83%

“…There are few references in the literature to the long-term effects of bile on the gastric mucosa, and they are conflicting [11][12][13][14][15][16]. Our experiments indicate that bile induces important alterations in the gastric mucosa of the dog.…”

Section: Discussionmentioning

confidence: 78%

Long‐term effects of bile on the gastric mucosa of the dog

Oliveira

Azevedo

1980

World j. surg.

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“…(2) Excessive enterogastric reflux and gas tritis: Association of excessive enterogastric reflux and gastric mucosal injury has been the subject of many communications in the past decade [25][26][27] [31], that the reaction is activated by both trypsin and bile acids [32], and that lysoleci thin can damage gastric mucosa [ [42]. This study, however, has been criticized for using a nonphysiologic solution of sodium hydroxide with a pH of 11 and its poorly controlled design.…”

Section: Pathophysiologymentioning

confidence: 99%

Reflux Gastritis Syndrome

Meshkinpour

Wittles

1987

Dig Dis

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“…Diese Hypothese wird noch am ehesten durch die vorliegenden tierexperimentellen Untersuchungen gestfitzt [8,9,18,25,27], wenngleich die Erzeugung einer Gastritis durch galligen Reflux nicht immer gelang [3,10,29,31,41]. Zumindest nach Antrektomie war im Tierexperiment eine Gastritis, die nach Ableitung des Duodenalsaftes durch eine Roux-Y-Anastomose zur Abheilung gebracht werden konnte, nachzuweisen [20,21].…”

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24. Chirurgische Aspekte nach Resektionen an Magen und Oesophagus

Siewert¹

1980

Langenbecks Arch Chiv

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Resection of digestive sphincters like the pylorus (antrum) or the cardia (terminal esophagus) means reflux. Reflux is, however, not to be confused with reflux disease. Only pathologically prolonged contact of regurgitation with mucosa provides presupposition of reflux symptoms. Bilious vomit and epigastric pain are clinical symptoms of gastral reflux disease; the morphological consequence is erythemia of the stomach. Whether gastritis is also a result of reflux must remain undecided at present. The proven surgical therapy of gastral reflux disease is the Roux-en-Y operation. Esophageal reflux consequences after total gastrectomy alad cardia resection are of great clinical importance. Their prophylaxis should be a deciding factor for the method chosen. -terminaler Oesophagus) bedeutet Reflux. Reflux ist aber nicht gleich Refluxkrankheit zu setzen. Nur ein pathologisch verl/ingerter Kontakt zwischen Regurgitat und Schleimhaut schafft die Voraussetzung ffir die Entstehung von Refluxfolgen. Galleerbrechen und epigastrischer Schmerz sind klinische Symptome der gastralen Refluxkrankheit, das Magenerythem morphologische Folge. Ob auch die Gastritis Refluxfolge ist, muB z. Z. noch often bleiben. Belegte chirurgische Therapie der gastralen Refluxkrankheit ist die Roux-Y-Ableitung des Duodenalinhaltes. Oesophageale Refluxfolgen sind nach totaler Gastrektomie und nach Kardiaresektion von groBer klinischer Bedeutung. Ihre Prophylaxe sollte Gegenstand der Verfahrenswahl sein. Schliisselwiirter: Distale Magenresektion -Gastrale Refluxkrankheit -Gallereflux -Oesophagealer Reflux. Zu rasche Entleerung oder Stase k6nnen nach resezierenden Eingriffen an Oesophagus und Magen entstehen, Reflux ist die Regel. Der Grund daf/ir ist die Beeintr~chtigung oder Entfernung von Strukturen, die fiir die Sicherstellung des Einbahnverkehrs im Gastrointestinaltrakt verantwortlich sind; dies sind im Bereich des oberen Gastrointestinaltraktes Pylorus und Antrum bzw. Kardia und distaler Oesophagus. Dieses Faktum ist in der Literatur gut belegt [1,2, 26, 33, 40]. Das AusmaB des Refluxes wird dabei vonder Art des Eingriffes bzw. vom Rekonstruktionstyp beeinfluBt. Eine Pyloroektomie allein fiihrt z. B. in geringerem Umfange zum Reflux als eine Pyloroplastik, die gleichzeitig auch eine SchS.digung des Antrums beinhaltet (z. B. Heinecke-Mikulicz). Im Rahmen der Magenresektion f/ihrt die retrocolische GE zu einem st/irkeren Reflux als die B I-Anastomose tibrigens unabh/ingig vom Anastomosierungstyp -oder der B IImit antecolischer GE und Braunscher Enteroanastomose [33]. Ist dieser durch eine Operation induzierte duodenogastrale Reflux gleich Refluxkrankheit zu setzen? Sicher nicht! Es bedarf vielmehr weiterer ungiinstiger Faktoren, damit ein Reflux Krankheitswert erlangt. Entscheidende Voraussetzung filr die Entstehung yon Refluxfolgen ist eine pathologisch verl~ngerte Kontaktzeit zwischen Regurgitat und Schleimhaut des vorgeschalteten Organs (Tabelle |). Diese Kontaktzeit kann pathologisch verl/ingert sein weil besonders viel Reflux stattfindet (Quanti...

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The Effect of Bile Reflux on the Gastric Mucosa

Cited by 15 publications

References 0 publications

Long‐term effects of bile on the gastric mucosa of the dog

Long‐term effects of bile on the gastric mucosa of the dog

Reflux Gastritis Syndrome

24. Chirurgische Aspekte nach Resektionen an Magen und Oesophagus

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