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. 1974 Oct;180(4):526–535. doi: 10.1097/00000658-197410000-00017

Surgical Management of Reflux Gastritis

J Lynwood Herrington Jr, John L Sawyers, William A Whitehead
PMCID: PMC1344135  PMID: 4415996

Abstract

Reflux gastritis is now recognized with increasing frequency as a complication following operations on the stomach which either remove, alter, or bypass the pyloric phincter mechanism. The entity may occasionally occur as a result of sphincter dysfunction in the patient who has not undergone prior gastric surgery. The diagnosis is made on the basis of symptoms (postprandial pain, bilious vomiting and weight loss), gastroscopic examination with biopsy and persistent hypochlorhydria. Remedial operation for correction of reflux is indicated in the presence of persistent symptoms when conservative measures fail. Only operative procedures which divert duodenal contents from the stomach or gastric remnant are effective. Both the isoperistaltic jejunal segment (Henley loop) and the Roux-en-Y diversion have been effective as remedial operations for reflux gastritis and merit greater awareness by gastroenterologists and surgeons. Our choice is the Roux-en-Y because of its technical simplicity and lower morbidity rate.

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Selected References

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

  1. Ayulo J. A. Cholestyramine in postvagotomy syndrome. Preliminary report. Am J Gastroenterol. 1972 Mar;57(3):207–225. [PubMed] [Google Scholar]
  2. BELOWSKI H. Does the duodenal content exert a harmful effect on the gastric mucosa? Experimental study. Gastroenterologia. 1962;98:233–238. doi: 10.1159/000202460. [DOI] [PubMed] [Google Scholar]
  3. Bartlett M. K., Burrington J. D. Bilious vomiting after gastric surgery. Experience with a modified Roux-Y loop for relief. Arch Surg. 1968 Jul;97(1):34–39. doi: 10.1001/archsurg.1968.01340010064004. [DOI] [PubMed] [Google Scholar]
  4. Bedi B. S., Debas H. T., Gillespie G., Gillespie I. E. Effect of bile salts on antral gastrin release. Gastroenterology. 1971 Feb;60(2):256–262. [PubMed] [Google Scholar]
  5. Black R. B., Roberts G., Rhodes J. The effect of healing on bile reflux in gastric ulcer. Gut. 1971 Jul;12(7):552–558. doi: 10.1136/gut.12.7.552. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. CAPPER W. M., WELBOURN R. B. Early post-cibal symptoms following gastrectomy; aetiological factors, treatment and prevention. Br J Surg. 1955 Jul;43(177):24–35. doi: 10.1002/bjs.18004317704. [DOI] [PubMed] [Google Scholar]
  7. CONYERS J. H., HALL R. A., LAING D., PULVERTAFT C. N., WILLSON-PEPPER J. K. The use and risk of the Roux-en-Y anastomosis in the relief of post-gastrectomy symptoms. Br J Surg. 1960 Mar;47:533–536. doi: 10.1002/bjs.18004720514. [DOI] [PubMed] [Google Scholar]
  8. Capper W. M., Airth G. R., Kilby J. O. A test for pyloric regurgitation. Lancet. 1966 Sep 17;2(7464):621–623. doi: 10.1016/s0140-6736(66)91930-1. [DOI] [PubMed] [Google Scholar]
  9. Capper W. M., Butler T. J., Buckler K. G. Alkaline areas in gastric mucosa after gastric surgery. Gut. 1966 Jun;7(3):220–222. doi: 10.1136/gut.7.3.220. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Capper W. M., Butler T. J., Kilby J. O. Reversal of non-Addisonian achlorhydria by a Roux-en-Y loop. Gut. 1967 Dec;8(6):612–613. doi: 10.1136/gut.8.6.612. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Coppinger W. R., Job H., DeLauro J. E., Westerbuhr L. M., McGlone F. B., Phillips R. G. Surgical treatment of reflux gastritis and esophagitis. Arch Surg. 1973 Apr;106(4):463–468. doi: 10.1001/archsurg.1973.01350160081013. [DOI] [PubMed] [Google Scholar]
  12. Davenport H. W. Destruction of the gastric mucosal barrier by detergents and urea. Gastroenterology. 1968 Feb;54(2):175–181. [PubMed] [Google Scholar]
  13. Delaney J. P., Cheng J. W., Butler B. A., Ritchie W. P., Jr Gastric ulcer and regurgitation gastritis. Gut. 1970 Aug;11(8):715–719. doi: 10.1136/gut.11.8.715. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Drapanas T., Bethea M. Reflux gastritis following gastric surgery. Ann Surg. 1974 May;179(5):618–627. doi: 10.1097/00000658-197405000-00014. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Fisher R. S., Cohen S. Pyloric-sphincter dysfunction in patients with gastric ulcer. N Engl J Med. 1973 Feb 8;288(6):273–276. doi: 10.1056/NEJM197302082880601. [DOI] [PubMed] [Google Scholar]
  16. Frederick P. L., Osborne M. P. The development of surgical procedures for the treatment of peptic ulceration of the stomach and duodenum. Surgery. 1965 Nov;58(5):884–903. [PubMed] [Google Scholar]
  17. HEBBEL R. The topography of chronic gastritis in otherwise normal stomachs. Am J Pathol. 1949 Jan;25(1):125–141. [PMC free article] [PubMed] [Google Scholar]
  18. Hamza K. N., DenBesten L. Bile salts producing stress ulcers during experimental shock. Surgery. 1972 Feb;71(2):161–167. [PubMed] [Google Scholar]
  19. Hirschowitz B. I., Luketic G. C. Endoscopy in the post-gastrectomy patient. An analysis of 580 patients. Gastrointest Endosc. 1971 Aug;18(1):27–30. doi: 10.1016/s0016-5107(71)74015-2. [DOI] [PubMed] [Google Scholar]
  20. JOHNSTON J. H., WELLS C. Revision to the Roux-en Y anastomosis for post-gastrectomy syndromes. Lancet. 1956 Sep 8;271(6941):479–481. doi: 10.1016/s0140-6736(56)91969-9. [DOI] [PubMed] [Google Scholar]
  21. Janowitz H. D. Bile in the stomach. Gastroenterology. 1969 Sep;57(3):356–357. [PubMed] [Google Scholar]
  22. Joseph W. L., Rivera R. A., O'Kieffe D. A., Geelhoed G. W., McCune W. S. Management of postoperative alkaline reflux gastritis. Ann Surg. 1973 Jun;177(6):655–659. doi: 10.1097/00000658-197306000-00003. [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. 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]
  24. LEES F., GRANDJEAN L. C. The gastric and jejunal mucosae in healthy patients with partial gastrectomy. AMA Arch Intern Med. 1958 May;101(5):943–951. doi: 10.1001/archinte.1958.00260170099013. [DOI] [PubMed] [Google Scholar]
  25. Lawson H. H. Gastritis and gastric ulceration. Br J Surg. 1966 Jun;53(6):493–496. doi: 10.1002/bjs.1800530603. [DOI] [PubMed] [Google Scholar]
  26. 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]
  27. MIMPRISS T. W., BIRT S. J. M. Results of partial gastrectomy for peptic ulcer. Br Med J. 1948 Dec 25;2(4590):1095–1099. doi: 10.1136/bmj.2.4590.1095. [DOI] [PMC free article] [PubMed] [Google Scholar]
  28. Mackay I. R., Hislop I. G. Chronic gastritis and gastric ulcer. Gut. 1966 Jun;7(3):228–233. doi: 10.1136/gut.7.3.228. [DOI] [PMC free article] [PubMed] [Google Scholar]
  29. Menguy R., Max M. H. Influence of bile on the canine gastric-antral mucosa. Am J Surg. 1970 Feb;119(2):177–182. doi: 10.1016/0002-9610(70)90030-9. [DOI] [PubMed] [Google Scholar]
  30. Nahrwold D. L. Bile as a gastric secretory stimulant. Surgery. 1972 Feb;71(2):157–160. [PubMed] [Google Scholar]
  31. PALMER E. D. Gastritis: a revaluation. Medicine (Baltimore) 1954 Sep;33(3):199–290. doi: 10.1097/00005792-195409000-00002. [DOI] [PubMed] [Google Scholar]
  32. Pyrtek L. J., Bartus S. A. Reflux bile gastritis. Am J Surg. 1973 Apr;125(4):408–412. doi: 10.1016/0002-9610(73)90073-1. [DOI] [PubMed] [Google Scholar]
  33. ROUX G., PEDOUSSAUT R., MARCHAL G. Le syndrome de l'anse afférente des gastrectomises. Lyon Chir. 1950 Oct;45(7):773–780. [PubMed] [Google Scholar]
  34. Rhodes J., Barnardo D. E., Phillips S. F., Rovelstad R. A., Hofmann A. F. Increased reflux of bile into the stomach in patients with gastric ulcer. Gastroenterology. 1969 Sep;57(3):241–252. [PubMed] [Google Scholar]
  35. Ritchie W. P., Jr, Cheng J. W., Delaney J. P. Changes in parietal and chief cell populations following vagotomy and antrectomy. Surg Forum. 1969;20:319–320. [PubMed] [Google Scholar]
  36. Ritchie W. P., Jr, Delaney J. P. Sssceptibility of experimental atrophic gastritis to ulceration. Gastroenterology. 1971 Apr;60(4):554–559. [PubMed] [Google Scholar]
  37. SCHINDLER R. On the comparison between gastric suction biopsies and gastroscopy. Am J Dig Dis. 1955 Dec;22(12):336–337. doi: 10.1007/BF02886461. [DOI] [PubMed] [Google Scholar]
  38. SCOTT H. W., Jr, WEIDNER M. G. Total gastrectomy with Roux-en-Y esophagojejunostomy in treatment of gastric cancer. Ann Surg. 1956 May;143(5):682–696. doi: 10.1097/00000658-195605000-00015. [DOI] [PMC free article] [PubMed] [Google Scholar]
  39. Scudamore H. H., Eckstam E. E., Fencil W. J., Jaramillo C. A. Bile reflux gastritis. Diagnosis, medical and surgical therapy. Am J Gastroenterol. 1973 Jul;60(1):9–22. [PubMed] [Google Scholar]
  40. Skillman J. J., Gould S. A., Chung R. S., Silen W. The gastric mucosal barrier: clinical and experimental studies in critically ill and normal man, and in the rabbit. Ann Surg. 1970 Oct;172(4):564–584. doi: 10.1097/00000658-197010000-00004. [DOI] [PMC free article] [PubMed] [Google Scholar]
  41. Toye D. K., Williams J. A. Post-gastrectomy bile vomiting. Lancet. 1965 Sep 11;2(7411):524–526. doi: 10.1016/s0140-6736(65)91475-3. [DOI] [PubMed] [Google Scholar]
  42. van Heerden J. A., Priestley J. T., Farrow G. M., Phillips S. F. Postoperative alkaline reflux gastritis. Surgical implications. Am J Surg. 1969 Sep;118(3):427–433. doi: 10.1016/0002-9610(69)90150-0. [DOI] [PubMed] [Google Scholar]

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