Skip to main content
PMC home page
Annals of Surgery logoLink to Annals of Surgery
. 1986 May;203(5):537–544. doi: 10.1097/00000658-198605000-00014

Alkaline reflux gastritis. Late results on a controlled trial of diagnosis and treatment.

W P Ritchie Jr
PMCID: PMC1251165  PMID: 3707233

Abstract

In 1977, a controlled, prospective trial was initiated to test the hypothesis that excessive enterogastric (EG) reflux was responsible for a unique postgastrectomy syndrome, "alkaline reflux gastritis." Late (42 +/- 3 months) follow-up on all treated patients (N = 14; Rx = 45 cm Roux Y limb) is reported. The following parameters were assessed in symptomatic (N = 11 nonrefluxers, 15 refluxers) and asymptomatic postgastrectomy patients (N = 9): CCK-stimulated scintographically determined EG reflux (EGRI %), intragastric (IG) concentration of bile acids (BA, mM), net bile acid reflux/hr (microM), maximum acid output (mEq/hr), intragastric pH, gastric emptying of 99Tc-labeled solids (T 1/2; minutes), gastritis score (GS = 0-15), and specific symptomotology. A significant linear relationship was noted between intragastric BA concentration and the severity of histologic gastritis in the residual gastric pouch. As a group, excessive refluxers demonstrated significantly greater IG BA concentration, net BA reflux/hour, and EGRI than did either nonrefluxers or controls. Gastritis score in this group was also greater, intragastric pH higher, and maximal acid output (MAO) lower. Gastric emptying was not different between groups. Following Roux (N = 14), reflux was eliminated early and late, pH fell, MAO increased, and gastritis improved. Early marked delays in emptying occurred but normalized late and were rarely a clinical problem. Early symptomatic results were pain eliminated in 14/14, nausea in 8/14, vomiting 11/14, bilious vomiting in 14/14. Complications were one marginal ulcer (no vagotomy), two severe delays in emptying (simultaneous Roux + vagotomy). Late symptomatic results were recurrent or persistent pain in 4/14, nausea in 7/14, vomiting in 5/14. Bilious vomiting remains eliminated.

Full text

PDF
537

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Boren C. H., Way L. W. Alkaline reflux gastritis: a reevaluation. Am J Surg. 1980 Jul;140(1):40–46. doi: 10.1016/0002-9610(80)90415-8. [DOI] [PubMed] [Google Scholar]
  2. Delaney J. P., Broadie T. A., Robbins P. L. Pyloric reflux gastritis: the offending agent. Surgery. 1975 Jun;77(6):764–772. [PubMed] [Google Scholar]
  3. Herrington J. L., Jr, Sawyers J. L., Whitehead W. A. Surgical management of reflux gastritis. Ann Surg. 1974 Oct;180(4):526–537. doi: 10.1097/00000658-197410000-00017. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Herrington J. L., Jr, Scott H. W., Jr, Sawyers J. L. Experience with vagotomy--antrectomy and Roux-en-Y gastrojejunostomy in surgical treatment of duodenal, gastric, and stomal ulcers. Ann Surg. 1984 May;199(5):590–597. doi: 10.1097/00000658-198405000-00014. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Hoare A. M., McLeish A., Thompson H., Alexander-Williams J. Selection of patients for bile diversion surgery: use of bile acid measurement in fasting gastric aspirates. Gut. 1978 Mar;19(3):163–165. doi: 10.1136/gut.19.3.163. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Hocking M. P., Vogel S. B., Falasca C. A., Woodward E. R. Delayed gastric emptying of liquids and solids following Roux-en-Y biliary diversion. Ann Surg. 1981 Oct;194(4):494–501. doi: 10.1097/00000658-198110000-00012. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. LAWSON H. H. EFFECT OF DUODENAL CONTENTS ON THE GASTRIC MUCOSA UNDER EXPERIMENTAL CONDITIONS. Lancet. 1964 Feb 29;1(7331):469–472. doi: 10.1016/s0140-6736(64)90800-1. [DOI] [PubMed] [Google Scholar]
  8. Lawson H. H. The reversibility of postgastrectomy alkaline reflux gastritis by a Roux-en-Y loop. Br J Surg. 1972 Jan;59(1):13–15. doi: 10.1002/bjs.1800590104. [DOI] [PubMed] [Google Scholar]
  9. Malagelada J. R., Phillips S. F., Shorter R. G., Higgins J. A., Magrina C., van Heerden J. A., Adson M. A. Postoperative reflux gastritis: pathophysiology and long-term outcome after Roux-en-Y diversion. Ann Intern Med. 1985 Aug;103(2):178–183. doi: 10.7326/0003-4819-103-2-178. [DOI] [PubMed] [Google Scholar]
  10. Mathias J. R., Fernandez A., Sninsky C. A., Clench M. H., Davis R. H. Nausea, vomiting, and abdominal pain after Roux-en-Y anastomosis: motility of the jejunal limb. Gastroenterology. 1985 Jan;88(1 Pt 1):101–107. doi: 10.1016/s0016-5085(85)80140-2. [DOI] [PubMed] [Google Scholar]
  11. Meshkinpour H., Elashoff J., Stewart H., 3rd, Sturdevant R. A. Effect of cholestyramine on the symptoms of reflux gastritis. A randomized, double blind, crossover study. Gastroenterology. 1977 Sep;73(3):441–443. [PubMed] [Google Scholar]
  12. Ritchie W. P. Alkaline reflux gastritis: a critical reappraisal. Gut. 1984 Sep;25(9):975–987. doi: 10.1136/gut.25.9.975. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Ritchie W. P., Jr Alkaline reflux gastritis. An objective assessment of its diagnosis and treatment. Ann Surg. 1980 Sep;192(3):288–298. doi: 10.1097/00000658-198009000-00003. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Tolin R. D., Malmud L. S., Stelzer F., Menin R., Makler P. T., Jr, Applegate G., Fisher R. S. Enterogastric reflux in normal subjects and patients with Bilroth II gastroenterostomy. Measurement of enterogastric reflux. Gastroenterology. 1979 Nov;77(5):1027–1033. [PubMed] [Google Scholar]
  15. Vogel S. B., Vair D. B., Woodward E. R. Alterations in gastrointestinal emptying of 99m-technetium-labeled solids following sequential antrectomy, truncal vagotomy and Roux-Y gastroenterostomy. Ann Surg. 1983 Oct;198(4):506–515. doi: 10.1097/00000658-198310000-00010. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. van Heerden J. A., Phillips S. F., Adson M. A., McIlrath D. C. Postoperative reflux gastritis. Am J Surg. 1975 Jan;129(1):82–88. doi: 10.1016/0002-9610(75)90172-5. [DOI] [PubMed] [Google Scholar]

Articles from Annals of Surgery are provided here courtesy of Lippincott, Williams, and Wilkins

RESOURCES