[Duodenogastric and gastroesophageal bile reflux].
This study reviews current data regarding duodenogastric and gastroesophageal bile reflux-pathophysiology, clinical presentation, methods of diagnosis (namely, 24-hour intraluminal bile monitoring) and therapeutic management. Duodenogastric reflux (DGR) consists of retrograde passage of alkaline duodenal contents into the stomach; it may occur due to antroduodenal motility disorder (primary DGR) or may arise following surgical alteration of gastoduodenal anatomy or because of biliary pathology (secondary DGR). Pathologic DGR may generate symptoms of epigastric pain, nausea, and bilious vomiting. In patients with concomitant gastroesophageal reflux, the backwash of duodenal content into the lower esophagus can cause mixed (alkaline and acid) reflux esophagitis, and lead, in turn, to esophageal mucosal damage such as Barrett's metaplasia and adenocarcinoma. The treatment of DGR is difficult, non-specific, and relatively ineffective in controlling symptoms. Proton pump inhibitors decrease the upstream effects of DGR on the esophagus by decreasing the volume of secretions; promotility agents diminish gastric exposure to duodenal secretions by improving gastric emptying. In patients with severe reflux resistant to medical therapy, a duodenal diversion operation such as the duodenal switch procedure may be indicated.
Mabrut
J Y
JY
Service de Chirurgie Générale, Digestive et de Transplantation Hépatique, Hôpital de la Croix-Rousse - Lyon. jean-yves.mabrut@chu-lyon.fr
Collard
J M
JM
Baulieux
J
J
D000837:Anion Exchange Resins / Q000627:therapeutic use; D000897:Anti-Ulcer Agents / Q000627:therapeutic use; D001471:Barrett Esophagus / Q000209:etiology / Q000503:physiopathology; D001647:Bile Acids and Salts / Q000032:analysis; D002763:Cholecystectomy / Q000009:adverse effects; D002792:Cholestyramine Resin / Q000627:therapeutic use; D002851:Chromatography, High Pressure Liquid; D020117:Cisapride / Q000627:therapeutic use; D004383:Duodenogastric Reflux / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000601:surgery / Q000628:therapy; D004386:Duodenum / Q000601:surgery; D004942:Esophagitis, Peptic / Q000209:etiology / Q000503:physiopathology; D005745:Gastric Acidity Determination; D005764:Gastroesophageal Reflux / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D005765:Gastrointestinal Agents / Q000627:therapeutic use; D015391:Gastroplasty; D016481:Helicobacter Infections / Q000150:complications; D016480:Helicobacter pylori; D006801:Humans; D006863:Hydrogen-Ion Concentration; D054328:Proton Pump Inhibitors; D012307:Risk Factors; D013274:Stomach Neoplasms / Q000209:etiology; D013392:Sucralfate / Q000627:therapeutic use
D000837:Anion Exchange Resins; D000897:Anti-Ulcer Agents; D001647:Bile Acids and Salts; D005765:Gastrointestinal Agents; D054328:Proton Pump Inhibitors; D002792:Cholestyramine Resin; D013392:Sucralfate; D020117:Cisapride