Pathologic duodenogastric reflux associated with persistence of symptoms after cholecystectomy.
BACKGROUND
The aim of this study was to determine whether increased duodenogastric reflux contributes to postcholecystectomy symptoms.


METHODS
Gastric pH monitoring, hepatobiliary scintigraphy, gastric emptying scans, and gastric acid analysis were performed in asymptomatic (n = 10) and in symptomatic (n = 27) patients after cholecystectomy. Normal subjects (n = 20), patients with dyspepsia related to gastric acid hypersecretion (n = 20), patients with reflux gastritis after gastric surgery (n = 10), and patients with confirmed primary pathologic duodenogastric reflux (n = 10) were studied as controls. Symptomatic patients also underwent upper gastrointestinal endoscopy.


RESULTS
Symptomatic patients had significantly increased interprandial gastric exposure to pH < 3 compared with asymptomatic subjects, which correlated well with a high incidence of hepatobiliary scans positive for abnormal duodenogastric reflux and chronic gastritis on endoscopy. Gastric alkaline exposure in symptomatic patients was similar to that seen in patients with primary pathologic duodenogastric reflux and patients with duodenogastric reflux related to gastric surgery. Gastric acid secretion and gastric emptying were not altered. Five patients tested before and after laparoscopic cholecystectomy showed that nocturnal gastric alkalization was enhanced after operation.


CONCLUSIONS
This study suggests that excessive duodenogastric reflux may be responsible for persistence of symptoms after cholecystectomy.
Wilson
P
P
Department of Surgery, Creighton University School of Medicine, Omaha, NE 68131, USA.
Jamieson
J R
JR
Hinder
R A
RA
Anselmino
M
M
Perdikis
G
G
Ueda
R K
RK
DeMeester
T R
TR
D000328:Adult; D000368:Aged; D002763:Cholecystectomy; D004383:Duodenogastric Reflux / Q000209:etiology* / Q000503:physiopathology; D004415:Dyspepsia / Q000503:physiopathology; D005260:Female; D005745:Gastric Acidity Determination; D005746:Gastric Emptying; D005755:Gastrins / Q000097:blood; D005766:Gastrointestinal Contents; D006801:Humans; D007098:Imino Acids; D008297:Male; D008875:Middle Aged; D015609:Organotechnetium Compounds; D011183:Postoperative Complications / Q000453:epidemiology / Q000503:physiopathology*; D011187:Posture; D012016:Reference Values; D019785:Technetium Tc 99m Disofenin
D005755:Gastrins; D007098:Imino Acids; D015609:Organotechnetium Compounds; D019785:Technetium Tc 99m Disofenin