Duodenogastric reflux before and after surgical or medical therapy for duodenal ulcer.
Duodenogastric reflux was studied in 48 duodenal ulcer patients before and after medical (n = 8) or surgical therapy with either combined truncal vagotomy and gastrojejunostomy (n = 13) or pyloroplasty (n = 12), Polya partial gastrectomy (n = 8), or highly selective vagotomy (n = 7). Seven healthy subjects served as controls. The reflux was assessed both by using 99mTc diethyliminodiacetic acid (HIDA) scintigraphy and by measuring intragastric bile acid levels following endoscopic gastric juice aspiration. Before therapy, duodenal ulcer patients had significantly higher intragastric bile acid concentrations than did normal subjects (p less than 0.001). After truncal vagotomy and drainage, or partial gastrectomy, bile acid levels increased significantly, whereas they remained unchanged after medical therapy. Conversely, they were found to be significantly decreased after highly selective vagotomy. The results of HIDA scan measurements were compatible with those of gastric juice bile acids. We conclude that surgical treatment for duodenal ulcer by highly selective vagotomy is the only form of therapy, among the types considered, that leads to a reduction in duodenogastric reflux. It is of interest that medical therapy of the duodenal ulcer does not improve abnormal duodenogastric reflux, possibly contributing to both the failure of the medical treatment and recurrence of the ulcer.
Avgerinos
A
A
Second Department of Gastroenterology, Evangelismos Hospital, Athens, Greece.
Stavropoulos
G S
GS
Yalouris
A
A
Rekoumis
G
G
Stavraka-Kakavaki
A
A
Raptis
S
S
D001647:Bile Acids and Salts / Q000032:analysis; D004381:Duodenal Ulcer / Q000150:complications / Q000628:therapy*; D004383:Duodenogastric Reflux / Q000000981:diagnostic imaging / Q000209:etiology*; D004384:Duodenoscopy; D005743:Gastrectomy; D005750:Gastric Juice / Q000032:analysis; D005774:Gastrostomy; D006635:Histamine H2 Antagonists / Q000627:therapeutic use; D006801:Humans; D007098:Imino Acids; D007582:Jejunostomy; D015609:Organotechnetium Compounds; D011446:Prospective Studies; D011708:Pylorus / Q000601:surgery; D011877:Radionuclide Imaging; D019780:Technetium Tc 99m Lidofenin; D014628:Vagotomy / Q000379:methods
D001647:Bile Acids and Salts; D006635:Histamine H2 Antagonists; D007098:Imino Acids; D015609:Organotechnetium Compounds; D019780:Technetium Tc 99m Lidofenin