- Definition
- Endoscopic and histological signs of gastritis typically as a result of alteration in pyloric function (eg post-op)
- Attributing symptoms is problematic, as most patients with bile reflux are asymptomatic
- Incidence
- symptoms may occur months or years after an index operation
- Classification
- Primary: de novo
- Secondary: related to previous operation
- Etiology
- Due to regurgitation of bile into the stomach because of:
- An incompetent pyloric sphincter
- Abnormal duodenal motility
- Operative changes –
- Gastric surgery (gastroenterostomy (especially Billroth II), pyloroplasty)
- Even lap cholecystectomy
- Concomitant infection with H.pylori can cause increased inflammation
- Clinical
- Patients commonly asymptomatic
- Abdo pain, bilious vomiting, weight loss
- Pathology
- Bile salts and lecithin cause gastric mucosal injury
- Investigations
- Endoscopy: Bx & CLO test
- 24hr gastric pH &/or gastric bilirubin (or bile salt) monitoring
- Scintigraphic detection of bile in stomach (bile reflux scan)
- Management
- Test for and eradicate H. pylori
- Medical management (limited success):
- Ursodeoxycholic acid → improves Sx but not histology
- Sucralfate → improves histology, but not Sx
- Rabeprazole (same results as sucralfate)
- PG E2
- Cholestyramine and alginates
- Definitive management is surgery (revision & Roux-en-Y)
- Get improved symptoms in 50-90%
- Uncommon to ‘cure’ pt of all symptoms
- Surgery for primary reflux is rare: ‘duodenal switch’
- Prognosis / Natural Hx:
- May be a risk factor the development of antral metaplastic gastritis
- Improvement from surgery less likely in patients with delayed gastric emptying