title: Duodenal switch operation for pathologic transpyloric duodenogastric reflux.
abstract: OBJECTIVE
  To assess the long-term results of the duodenal switch operation made for pathologic transpyloric duodenogastric reflux (DGR).
  
  
  BACKGROUND
  DGR symptoms and lesions are poorly responsive to medical treatment.
  
  
  METHODS
  A duodenal switch operation was made on 48 patients suffering from pathologic transpyloric DGR either unrelated (n = 28) or secondary (n = 20) to previous upper gastrointestinal (GI) surgery, including cholecystectomy or vagotomy. The diagnosis was based on the combination of several objective arguments: a long history of gastric symptoms (ie, nausea, epigastric pain, and/or bilious vomiting) poorly responsive to medical treatment (48 of 48), gastroesophageal reflux symptoms unresponsive to proton-pump inhibitors (PPI) (23 of 29), gastritis on upper GI endoscopy (37 of 48) and/or at histology (28 of 41), presence of a bilious gastric lake at >1 upper GI endoscopy (30 of 48), DGR at diisopropyl iminodiacetic acid (DISIDA) scintigraphy scanning (7 of 13), pathologic 24-hour intragastric bile monitoring with the Bilitec device (40 of 41), and absence of Helicobacter pylori antral infection (39 of 41).
  
  
  RESULTS
  At follow-up (median, 81 months), gastric symptoms were nil, had improved, and remained unchanged in 29 (60.4%), 16 (33.3%), and 2(4.2%) patients, respectively, and 1 patient experienced symptomatic recurrence after a 92-month symptom-free period (2.1%). Among the 44 patients who had postoperative upper GI endoscopy, 42 (95.5%) had no gastritis whereas 5 (11.3%) had an ulcer at the duodenojejunostomy. Gastric exposure to bile at postoperative 24-hour intragastric Bilitec test in 36 patients was nil, within the normal range, and still slightly pathologic in 15 (41.7%), 19 (52.8%), and 2 (5.5%), respectively.
  
  
  CONCLUSIONS
  The duodenal switch operation made on patients in whom diagnosis of pathologic transpyloric DGR is supported by several objective arguments provides most of them with symptomatic and endoscopic improvement parallel to abolishment or normalization of gastric exposure to bile. Postoperative PPI therapy during a 2-month period is to be recommended to prevent the development of an anastomotic ulcer.
authors.affiliation: Saint Luc Academic Hospital, Brussels, Belgium.
authors.forename: Paolo
authors.initials: P
authors.lastname: Strignano
authors.forename: Jean-Marie
authors.initials: JM
authors.lastname: Collard
authors.forename: Jean-Marie
authors.initials: JM
authors.lastname: Michel
authors.forename: Renato
authors.initials: R
authors.lastname: Romagnoli
authors.forename: Jean-Paul
authors.initials: JP
authors.lastname: Buts
authors.forename: Charles
authors.initials: C
authors.lastname: De Gheldere
authors.forename: Francesco
authors.initials: F
authors.lastname: Volonté
authors.forename: Mauro
authors.initials: M
authors.lastname: Salizzoni
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical; D001646:Bile / Q000378:metabolism; D004383:Duodenogastric Reflux / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D004386:Duodenum / Q000601:surgery*; D016099:Endoscopy, Gastrointestinal; D005260:Female; D005500:Follow-Up Studies; D005746:Gastric Emptying / Q000502:physiology; D006801:Humans; D007583:Jejunum / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011708:Pylorus / Q000473:pathology / Q000503:physiopathology; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome