title: Duodenogastric reflux after biliary surgery: scintigraphic quantification and improvement with erythromycin.
abstract: BACKGROUND
  Persistence of dyspeptic symptoms after cholecystectomy or choledochoduodenostomy is common. There is -evidence that at least some of these symptoms may be attributed to duodenogastric reflux (DGR). The aim of the study was to quantify DGR before and after cholecystectomy, with or without choledochoduodenostomy, and endoscopic sphincterotomy for common bile duct stones, and to assess the effect of erythromycin on the increased DGR.
  
  
  METHODS
  Forty-seven patients before and after cholecystectomy, 26 after cholecystectomy and choledochoduodenostomy and nine after sphincterotomy had postprandial (300 mL of fresh milk, 4% fat) duodenogastric reflux measured by 99mTc-hepatic imino diacetic acid scintigraphy. Patients with a DGR index (DGRi) >20% were considered as having pathological DGR that justifies symptoms, and their DGRi was reassessed after administration of 200 mg of erythromycin intravenously.
  
  
  RESULTS
  Twenty-seven patients before cholecystectomy (57%) showed a normal DGRi <7%. In five cases DGRi was greater than 20%. After cholecystectomy, duodenogastric refluxes increased, so that only 16 patients (32%) showed a normal DGRi, while a DGRi >20% was observed in 10 cases. Only eight patients after cholecystectomy and choledochoduodenostomy (23%) presented with a DGRi within the normal range. The remaining 18 had a DGRi >7%. Five of them exhibited a DGRi >20%. Of the nine patients with sphincterotomy, three showed a DGRi >20%. Erythromycin almost completely normalized DGRi in all 18 patients with pathological DGR (P < 0.0001).
  
  
  CONCLUSIONS
  Duodenogastric reflux is common after biliary surgery, including endoscopic sphincterotomy. Erythromycin appears to decrease duodenogastric reflux to normal levels.
authors.affiliation: Unit of Gastrointestinal Motility, University Hospital, University of Crete Medical School, Heraklion, Greece.
authors.forename: Alexandros
authors.initials: A
authors.lastname: Fountos
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Chrysos
authors.forename: John
authors.initials: J
authors.lastname: Tsiaoussis
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Karkavitsas
authors.forename: Odysseas J
authors.initials: OJ
authors.lastname: Zoras
authors.forename: Asterios
authors.initials: A
authors.lastname: Katsamouris
authors.forename: Evaghelos
authors.initials: E
authors.lastname: Xynos
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002763:Cholecystectomy / Q000009:adverse effects*; D002768:Choledochostomy / Q000009:adverse effects; D004383:Duodenogastric Reflux / Q000188:drug therapy / Q000209:etiology*; D004917:Erythromycin / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016717:Sphincterotomy, Endoscopic / Q000009:adverse effects
chemical_list: D004917:Erythromycin