Abstract
A high incidence of possible premalignant conditions of the gastric mucosa has been reported in the postoperative stomach and it has been suggested that bile plays a role in their pathogenesis. Fifty eight patients who had had a vagotomy and gastrojejunostomy between 1957 and 1967 underwent endoscopy and biopsy. Subsequently, samples of fasting and postprandial gastric juice were taken from all patients for analysis of total bile acid. The patients were divided into three histological groups: group 1 (24 patients) had gastritis or mucosal atrophy but no more than mild dysplasia; group 2 (23 patients) had intestinal metaplasia in one or more biopsies; group 3 (11 patients) had moderate or severe dysplasia in one or more biopsies. Group 2 and group 3 patients had higher fasting intragastric bile acid concentrations than group 1 (p less than 0.01 in both cases). There was no difference between fasting bile acid concentrations in groups 2 and 3. In the postprandial phase groups 2 and 3 also had higher peak intragastric concentrations than group 1 (p less than 0.01 in both cases). Again, there was no significant difference between groups 2 and 3. It is concluded that there is a relation between mucosal abnormality in the postoperative stomach and intragastric bile acid concentration. The possible aetiological link between bile acid and these mucosal abnormalities is discussed.
Full text
PDF




Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Dewar P., King R., Johnston D. Bile acid and lysolecithin concentrations in the stomach in patients with duodenal ulcer before operation and after treatment by highly selective vagotomy, partial gastrectomy, or truncal vagotomy and drainage. Gut. 1982 Jul;23(7):569–577. doi: 10.1136/gut.23.7.569. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Domellöf L., Eriksson S., Janunger K. G. Carcinoma and possible precancerous changes of the gastric stump after billroth II resection. Gastroenterology. 1977 Sep;73(3):462–468. [PubMed] [Google Scholar]
- Domellöf L., Eriksson S., Janunger K. G. Late precancerous changes and carcinoma of the gastric stump after Billroth I resection. Am J Surg. 1976 Jul;132(1):26–31. doi: 10.1016/0002-9610(76)90284-1. [DOI] [PubMed] [Google Scholar]
- Domellöf L. Gastric carcinoma promoted by alkaline reflux gastritis -- with special reference to bile and other surfactants as promoters of postoperative gastric cancer. Med Hypotheses. 1979 Apr;5(4):463–476. doi: 10.1016/0306-9877(79)90112-9. [DOI] [PubMed] [Google Scholar]
- Domellöf L., Reddy B. S., Weisburger J. H. Microflora and deconjugation of bile acids in alkaline reflux after partial gastrectomy. Am J Surg. 1980 Aug;140(2):291–295. doi: 10.1016/0002-9610(80)90024-0. [DOI] [PubMed] [Google Scholar]
- Farrands P. A., Blake J. R., Ansell I. D., Cotton R. E., Hardcastle J. D. Endoscopic review of patients who have had gastric surgery. Br Med J (Clin Res Ed) 1983 Mar 5;286(6367):755–758. doi: 10.1136/bmj.286.6367.755. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Fausa O., Skålhegg B. A. Quantitative determination of bile acids and their conjugates using thin-layer chromatography and a purified 3alpha-hydroxysteroid dehydrogenase. Scand J Gastroenterol. 1974;9(3):249–254. [PubMed] [Google Scholar]
- Heading R. C. Duodenogastric reflux. Gut. 1983 Jun;24(6):507–509. doi: 10.1136/gut.24.6.507. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Hill M. J., Drasar B. S., Hawksworth G., Aries V., Crowther J. S., Williams R. E. Bacteria and aetiology of cancer of large bowel. Lancet. 1971 Jan 16;1(7690):95–100. doi: 10.1016/s0140-6736(71)90837-3. [DOI] [PubMed] [Google Scholar]
- Hoare A. M., Keighley M. R., Starkey B., Alexander-Williams J. Measurement of bile acids in fasting gastric aspirates: an objective test for bile reflux after gastric surgery. Gut. 1978 Mar;19(3):166–169. doi: 10.1136/gut.19.3.166. [DOI] [PMC free article] [PubMed] [Google Scholar]
- KRAUSE U. Late prognosis after partial gastrectomy for ulcer; a follow-up study of 361 patients operated upon from 1905 to 1933. Acta Chir Scand. 1958 Apr 15;114(5):341–354. [PubMed] [Google Scholar]
- Milton-Thompson G. J., Lightfoot N. F., Ahmet Z., Hunt R. H., Barnard J., Bavin P. M., Brimblecombe R. W., Darkin D. W., Moore P. J., Viney N. Intragastric acidity, bacteria, nitrite, and N-nitroso compounds before, during, and after cimetidine treatment. Lancet. 1982 May 15;1(8281):1091–1095. doi: 10.1016/s0140-6736(82)92277-2. [DOI] [PubMed] [Google Scholar]
- Morson B. C., Sobin L. H., Grundmann E., Johansen A., Nagayo T., Serck-Hanssen A. Precancerous conditions and epithelial dysplasia in the stomach. J Clin Pathol. 1980 Aug;33(8):711–721. doi: 10.1136/jcp.33.8.711. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Mosimann F., Burri B., Diserens H., Fontolliet C., Loup P., Mosimann R. Enterogastric reflux; experimental and clinical study: a preliminary report. Scand J Gastroenterol Suppl. 1981;67:149–152. [PubMed] [Google Scholar]
- Mosimann R., Loup P., Fontolliet C., Mosimann F. Post-operative reflux gastritis: results of surgical treatment. Scand J Gastroenterol Suppl. 1981;67:237–239. [PubMed] [Google Scholar]
- Muscroft T. J., Deane S. A., Youngs D., Burdon D. W., Keighley M. R. The microflora of the postoperative stomach. Br J Surg. 1981 Aug;68(8):560–564. doi: 10.1002/bjs.1800680813. [DOI] [PubMed] [Google Scholar]
- Oehlert W., Keller P., Henke M., Strauch M. Gastric mucosal dysplasia: what is its clinical significance? Front Gastrointest Res. 1979;4:173–182. doi: 10.1159/000402299. [DOI] [PubMed] [Google Scholar]
- Papachristou D. N., Agnanti N., Fortner J. G. Gastric carcinoma after treatment of ulcer. Am J Surg. 1980 Feb;139(2):193–196. doi: 10.1016/0002-9610(80)90252-4. [DOI] [PubMed] [Google Scholar]
- Reddy B. S., Narasawa T., Weisburger J. H., Wynder E. L. Promoting effect of sodium deoxycholate on colon adenocarcinomas in germfree rats. J Natl Cancer Inst. 1976 Feb;56(2):441–442. doi: 10.1093/jnci/56.2.441. [DOI] [PubMed] [Google Scholar]
- Reed P. I., Smith P. L., Haines K., House F. R., Walters C. L. Gastric juice N-nitrosamines in health and gastroduodenal disease. Lancet. 1981 Sep 12;2(8246):550–552. doi: 10.1016/s0140-6736(81)90939-9. [DOI] [PubMed] [Google Scholar]
- Reynolds K. W., Johnson A. G., Fox B. Is intestinal metaplasia of the gastric mucosa a pre-malignant lesion? Clin Oncol. 1975 Jun;1(2):101–109. [PubMed] [Google Scholar]
- 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]
- Ross A. H., Smith M. A., Anderson J. R., Small W. P. Late mortality after surgery for peptic ulcer. N Engl J Med. 1982 Aug 26;307(9):519–522. doi: 10.1056/NEJM198208263070902. [DOI] [PubMed] [Google Scholar]
- Ruddell W. S., Bone E. S., Hill M. J., Blendis L. M., Walters C. L. Gastric-juice nitrite. A risk factor for cancer in the hypochlorhydric stomach? Lancet. 1976 Nov 13;2(7994):1037–1039. doi: 10.1016/s0140-6736(76)90962-4. [DOI] [PubMed] [Google Scholar]
- Schmähl D., Habs M. Carcinogenicity of N-nitroso compounds. Species and route differences in regard to organotropism. Oncology. 1980;37(4):237–242. doi: 10.1159/000225444. [DOI] [PubMed] [Google Scholar]
- Schrumpf E., Serck-Hanssen A., Stadaas J., Aune S., Myren J., Osnes M. Mucosal changes in the gastric stump 20-25 years after partial gastrectomy. Lancet. 1977 Sep 3;2(8036):467–469. doi: 10.1016/s0140-6736(77)91599-9. [DOI] [PubMed] [Google Scholar]
- Stalsberg H., Taksdal S. Stomach cancer following gastric surgery for benign conditions. Lancet. 1971 Nov 27;2(7735):1175–1177. doi: 10.1016/s0140-6736(71)90489-2. [DOI] [PubMed] [Google Scholar]
- Watt P. C., Sloan J. M., Donaldson J. D., Patterson C. C., Kennedy T. L. Relationship between histology and gastric juice pH and nitrite in the stomach after operation for duodenal ulcer. Gut. 1984 Mar;25(3):246–252. doi: 10.1136/gut.25.3.246. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Watt P. C., Sloan J. M., Kennedy T. L. Changes in gastric mucosa after vagotomy and gastrojejunostomy for duodenal ulcer. Br Med J (Clin Res Ed) 1983 Nov 12;287(6403):1407–1410. doi: 10.1136/bmj.287.6403.1407. [DOI] [PMC free article] [PubMed] [Google Scholar]
