The features and course of bile vomiting following gastric surgery

Griffiths, John M.

doi:10.1002/bjs.1800610807

Cited by 31 publications

(5 citation statements)

References 31 publications

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“…Bile vomiting, with associated dyspepsia, commonly occurs after surgery for peptic ulcer (Bushkin et al, 1974). These symptoms can be distressing but may improve within 6-18 months of surgery (Capper and Welbourn, 1955;Griffiths, 1974). Bile diversion operations may improve symptoms (Herrington et al, 1974;Van Heerden et al, 1975) but should be postponed until there is no longer any chance of spontaneous improvement .…”

Section: Discussionmentioning

confidence: 99%

Hydrotalcite in the treatment of bile vomiting

Hoare

McLeish

Thompson

et al. 1977

Journal of British Surgery

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Seventeen patients have completed a double-blind cross-over study of hydrotalcite against placebo in the treatment of bile vomiting after surgery for peptic ulcer. Overall there was no significant difference between the two treatments, with 9 patients improving on hydrotalcite and 5 on placebo. The original operation had been peformed less than 3 years before the study in 9 patients; in this subgroup there was an improvement on hydrotalcite treatment in 8 patients but in only 1 on placebo. These differences are statistically significant (P less than 0.005). Nausea, vomiting, heartburn and epigastric tenderness were improved although gastritis and endoscopic changes were not affected. It appears that hydrotalcite can help palliate symptoms of bile vomiting occuring soon after surgery for peptic ulcer.

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Section: Discussionmentioning

confidence: 99%

Hydrotalcite in the treatment of bile vomiting

Hoare

McLeish

Thompson

et al. 1977

Journal of British Surgery

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“…Al kaline reflux is constantly observed in patients after Bill roth II anastomosis. However, despite the amount of refluxed material into the gastric remnant and the fre quent presence of histological inflammatory changes, severe remnant gastritis is present only in a small num ber of cases [1], and no relationship can be found with the presence of dyspeptic symptoms. Experimentally some bile acids seem to exert damaging effects on the gastric mucosa more than others [2][3][4], probably because of their different detergent properties.…”

Section: Introductionmentioning

confidence: 95%

Alkaline Reflux Gastritis after Partial Gastrectomy: Evidence for a Pathogenetic Role of Deoxycholic Acid

et al. 1990

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30 subjects submitted to Billroth II resection for duodenal ulcer were divided in two groups: 15 patients with severe remnant gastritis at endoscopic examination confirmed by histology and 15 control subjects. Total concentrations of bile acids in gastric remnant and bile acid pattern were determined in all subjects. In 15 patients (8 controls and 7 with severe remnant gastritis) a scintigraphy with ^99mTc-HIDA to estimate enterogastric reflux with subsequent gastric evacuation of refluxate was performed. Fasting bile acid reflux rate, enterogastric reflux and gastric evacuation of refluxate from the remnant proved to be similar in the two groups. In contrast the qualitative analysis of biliary reflux showed an increase in the amount of deoxycholic acid in patients with severe remnant gastritis (p < 0.05), compared with controls; no differences have been observed as for the amount of other bile acids and taurine and glycine conjugates. Therefore the increase in deoxycholic acid, probably due to bacterial overgrowth reported after gastric surgery, may contribute to develop and maintain gastritis after Billroth II anastomosis. Our findings also support the hypothesis that deoxycholic acid – recently postulated to promote colonic carcinogenesis -may play a role in the increased prevalence of cancer observed in the gastric remnant after gastric surgery.

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“…After gastric surgery, many patients experience discomfort associated with regurgitation or vomiting of bile which may persist for several years (Griffiths, 1974). Medical treatment, including cholestyramine, is unsatisfactory (Scudamore et al, 1973), so that reconstructive surgery with a Roux-en-Y operation has been used and may relieve dyspepsia and bile vomiting (Conyers et al, 1960;Coppinger et al, 1973;Herrington et al, 1974;van Heerden et al, 1975).…”

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confidence: 99%

Selection of patients for bile diversion surgery: use of bile acid measurement in fasting gastric aspirates.

Hoare¹,

McLeish²,

Thompson³

et al. 1978

Gut

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SUMMARY Eighteen patients with dyspepsia and vomiting which followed surgery for peptic ulcer have completed a study to examine the role of diverting bile from the stomach by a Roux-en-Y procedure. Bile regurgitation and mild epigastric pain relieved by vomiting were abolished. Measurements of bile acids in the fasting gastric aspirate were useful in predicting the outcome of surgery; good results were obtained when initially there was reflux into the stomach of more than 120 ,mol/hour of bile acids. A wider group of patients than those selected in previous series may benefit from this operation, as good results can be obtained in patients with dyspepsia relieved by alkali and without achlorhydria or gastritis. Endoscopy was repeated one year after Roux-en-Y operation. Erythema of the mucosa was improved, but gastritis did not improve.After gastric surgery, many patients experience discomfort associated with regurgitation or vomiting of bile which may persist for several years (Griffiths, 1974). Medical treatment, including cholestyramine, is unsatisfactory (Scudamore et al., 1973), so that reconstructive surgery with a Roux-en-Y operation has been used and may relieve dyspepsia and bile vomiting (Conyers et al., 1960;Coppinger et al., 1973;Herrington et al., 1974;van Heerden et al., 1975). Most series of patients have been selected and include those with epigastric pain unrelieved by alkali or food (van Heerden et al., 1975) 16 September 1977 gastric surgery at least one year previously and recurrent ulceration or biliary disease had been excluded as a cause of their symptoms. Three were women and the average age was 50 years (range 33-66 years). The previous gastric operations were vagotomy and pyloroplasty in four, vagotomy and gastroenterostomy in two, vagotomy and antrectomy in three, Billroth I partial gastrectomy in two, and Billroth II in seven. On average the first operations had been performed 7-4 years ago (range one to 39 years). Ten patients had already had one unsuccessful revision operation that had not accomplished bile diversion. al., 1977b). The severity of the patient's symptoms were assessed by one physician, and the biopsies were examined without knowledge of their order by one person (H.T.) using the criteria of Whitehead et al. (1972) for the stomach and Ismail-Beigi et al. (1970) for the oesophagus.At operation a Roux-en-Y reconstruction was performed with the afferent loop of jejunum anastomosed to the side of the efferent loop at least 45 cm distal to the gastrojejunal stoma. If the insulin test 163 on 9 May 2018 by guest. Protected by copyright.

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The features and course of bile vomiting following gastric surgery

Cited by 31 publications

References 31 publications

Hydrotalcite in the treatment of bile vomiting

Hydrotalcite in the treatment of bile vomiting

Alkaline Reflux Gastritis after Partial Gastrectomy: Evidence for a Pathogenetic Role of Deoxycholic Acid

Selection of patients for bile diversion surgery: use of bile acid measurement in fasting gastric aspirates.

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