title: Cholecystectomy and duodenogastric reflux: interacting effects over the gastric mucosa.
abstract: OBJECTIVE
  To evaluate association between duodenogastric reflux and early gastric mucosal changes before and after the cholecystectomy procedure.
  
  
  METHODS
  Patients were evaluated with preoperative and postoperative endoscopy and endoscopic biopsy. Demographic and clinical characteristics, histological parameters, presence of duodenogastric reflux, and Updated Sydney scores were noted.
  
  
  RESULTS
  A total of fifty patients who obeyed the follow-up were enrolled into the study. Median age of the patients was 43 years (range 25-84). Male-female ratio was 0.51 (17/33). Duodenogastric reflux % and Updated Sydney scores before and after cholecystectomy were 24 (48%) versus 39 (78%) and 2.38 ± 2.21 versus 3.46 ± 3.05, respectively (p = 0.001, p < 0.000). Mucosal inflammation degree showed significant increase in 15 (30%) patients, decrease in 7 (14%) patients and equality in 28 (56%) patients (p = 0.037). Neutrophil activation degree was significantly higher in 21 (42%) patients, lower in 5 (10%) patients after the surgery (p = 0.005). Postoperative glandular atrophy degree was also higher in 13 (26%) patients and equal in 37 (74%) patients (p = 0.001). Pre- and postoperative degree of intestinal metaplasia andH. pyloridensity did not any show significant difference (p = 0.157, p = 0.248, respectively).There were significant positive correlation between postoperativeH. pyloriinfection and mucosal activity, inflammation, atrophy and intestinal metaplasia.
  
  
  CONCLUSIONS
  Cholecystectomy is a potent inducer of pathologic duodenogastric reflux. Early onset of duodenogastric reflux and underlyingH. pylorigastritis cause early gastric mucosal injury following cholecystectomy procedure by interacting collectively.
authors.affiliation: Department of General Surgery, Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey.
authors.forename: Erdinc
authors.initials: E
authors.lastname: Mercan
authors.affiliation: Department of General Surgery, Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey.
authors.forename: Ugur
authors.initials: U
authors.lastname: Duman
authors.affiliation: Department of General Surgery, Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey.
authors.forename: Deniz
authors.initials: D
authors.lastname: Tihan
authors.affiliation: Department of General Surgery, Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey.
authors.forename: Evren
authors.initials: E
authors.lastname: Dilektasli
authors.affiliation: Department of General Surgery, Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey ; Department of General Surgery, Bursa State Hospital, Bursa, Turkey.
authors.forename: Kazim
authors.initials: K
authors.lastname: Senol
keywords: H. pylori; Laparoscopic cholecystectomy; Reflux gastritis