Relative contribution of bile and pancreatic juice duodenogastric reflux in gastric ulcer disease and cholelithiasis.
Bile acid concentrations, phospholipase A2 activity and pH in the stomach were measured in the fasting state and for 2 h after a fat-containing test meal in patients with an active gastric ulcer (GU), in patients with gallstones before and after cholecystectomy and in normal subjects. Fasting and peak postprandial bile acid concentrations in the stomach were low in all normal controls. Although high concentrations were found in many patients with GU (P less than 0.01), similar concentrations were found in many patients with radiologically non-functioning gallbladders containing gallstones (NFG) (P less than 0.01) and also after cholecystectomy (AC) (P less than 0.01). Fasting intragastric phospholipase A2 activities were similar, and very high in GU and NFG patients compared with control subjects (P less than 0.01). High values were not found after cholecystectomy. There was no difference in pH profile or in postprandial phospholipase A2 between patient groups. Since patients with cholelithiasis or after cholecystectomy are not known to have an increased incidence of gastric ulceration, the significance of duodenogastric reflux in the aetiology of gastric ulcers must be questioned. If reflux does produce ulcers in GU patients then factors in addition to bile acid are probably involved. However, neither patterns of phospholipase A2 reflux nor pH profiles can explain the absence of gastric ulceration in those patients with gallstones who reflux large quantities of bile acid.
D000328:Adult; D000368:Aged; D001647:Bile Acids and Salts / Q000032:analysis*; D002769:Cholelithiasis / Q000150:complications* / Q000378:metabolism; D004383:Duodenogastric Reflux / Q000150:complications* / Q000378:metabolism; D005260:Female; D005745:Gastric Acidity Determination; D005753:Gastric Mucosa / Q000378:metabolism; D006801:Humans; D008297:Male; D008875:Middle Aged; D010740:Phospholipases / Q000378:metabolism*; D010741:Phospholipases A / Q000378:metabolism*; D054467:Phospholipases A2; D013276:Stomach Ulcer / Q000209:etiology* / Q000378:metabolism
D001647:Bile Acids and Salts; D010740:Phospholipases; D010741:Phospholipases A; D054467:Phospholipases A2