Abstracts
1997 Digestive Disease Week

Bile diversion alone for primary bile reflux gastritis.

JA Madura. Department of Surgery, Indiana University, Indianapolis, IN.

Symptomatic bile reflux gastritis (BRG) has been recognized as a disabling complication of gastric surgery for more than a century. Primary BRG has been less frequently diagnosed even though the mechanism and symptoms are the same. Underlying gastric dysmotility allowing prolonged contact of gastric mucosa and bile, has been frequently aggravated by vagotomy, gastric resection and Roux-en-Y anastomosis. Ten patients with intractable BRG have been diagnosed and treated between 1995 and 1996. There are seven women and three men whose average age is 49.3 +/- 15.7 years. (Range - 23 to 68 years). Previous operations included cholecystectomy (8), appendectomy (5), Nissen fundoplication (3), and hysterectomy in 6 of the 7 females. Symptoms were: epigastric pain 100%, nausea 90%, bilious vomiting 90%, and weight loss 50%. Mean weight loss was 12.1 kg in the 5 patients. Endoscopy showed gastritis in 7/10 pts, while DISIDA nuclear scan confirmed entero-gastric reflux in 6/10 patients. Scintigraphic measurement of gastric emptying was delayed in five patients and normal in five. One of three pts tested for helicobacter pylori was positive, but usual therapy failed to eliminate symptoms. All 10 pts underwent choledochojejunostomy to a 40 cm Roux-Y limb. T-Tubes were placed in all patients. Neither vagotomy nor gastric resection were done. There were no postop deaths, nor complications, and all 10 patients are asymptomatic and eating normally. Late gastric emptying is normal in all patients studied thus far. No bilioenteric leaks nor anastomotic strictures have been observed.

CONCLUSIONS: BRG frequently occurs following gastric surgery causing symptoms of burning epigastric pain, nausea, bilious vomiting and weight loss. These symptoms may also occur spontaneously in absence of previous gastric operations. Medical therapy is ineffective, and surgical correction with Roux-Y gastrojejunostomy, may result in worsened stasis. Diversion of bile flow away from the duodenum via a 40 cm. Roux-Y gastrojejunostomy provided relief of symptoms in all patients and thus far no long term problems have been encountered.