Abstract
Duodenogastric reflux (DGR) has been implicated in several disease processes. The present study was carried out to document the incidence and evaluate the clinical significance of DGR after choledochoduodenostomy (CDD). A total of 13 patients who had undergone cholecystectomy with a standard side-to-side CDD for choledocholithiasis or chronic pancreatitis were studied by symptom evaluation, scintigraphy, endoscopy, and gastric mucosal histology at least 6 months after surgery. The scintigraphic findings were then compared with those of 10 patients who had undergone cholecystectomy alone. Only two patients (15%) had mild dyspeptic symptoms. The incidence of DGR after CDD was 69% compared to 20% in the cholecystectomy alone group (P < 0.05). In the majority of patients the DGR was only mild to moderate and the severity correlated well with the degree of endoscopic gastritis, but not with the clinical symptoms or histological findings. These results indicate that while CDD is associated with a high incidence of DGR, its occurrence does not produce significant clinical symptoms.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Ritchie AP (1986) Alkaline reflux gastritis: late results on a controlled trial of diagnosis and treatment. Ann Surg 203:537–544
Keane FB, Dimagno EP, Malgelada JR (1981) Duodenogastric reflux in humans: its relationship to fasting antroduodenal motility and gastric, pancreatic, and biliary secretion. Gastroenterology 81:726–731
Stein HJ, Smyrk TC, DeMeester TR, Rouse J, Hinder RA (1992) Clinical value of endoscopy and histology in the diagnosis of duodenogastric reflux disease. Surgery 112:796–804
Van Heerden JA, Phillips SF, Adson MA, McIlrath DC (1975) Postoperative reflux gastritis. Am J Surg 129:82–88
Ludwig S, Ippoliti A (1979) Objective evaluation of symptomatic bile reflux after antrectomy. Gastroenterology 76:1187–1189
Gadacz TR, Zuidema GD (1978) Bile acid composition in patients with and without symptoms of postoperative reflux gastritis. Am J Surg 135:48–52
Avgerinos A, Stavropoulos MD, Yalouris A, Rekoumis G, Stavraka-Kakavaki A, Raptis S (1990) Duodenogastric reflux before and after surgical or medical therapy for duodenal ulcer. Am J Gastroenterol 85:150–153
Akiyama H, Ikezawa H, Kameya S, Iwasaki M, Kuroda Y, Takeshita T (1980) Unexpected problems of external choledochoduodenostomy — Fibrescopic examination in 15 patients. Am J Surg 140:660–665
Lujan-Mompean JA, Torralba-Martinez JA, Parrilla-Paricio P, Robles-Campos R, Liron-Ruiz R, Ramirez-Romero P (1994) Quantification of duodenogastric reflux in patients with choledochoduodenostomy. J Am Coll Surg 179:193–196
Brown TH, Walton G, Cheadle WG, Larson GM (1989) The alkaline shift in gastric pH after cholecystectomy. Am J Surg 157:58–65
Nano M, Palmas F, Giaccone M, Ricci E, Camandona M, Gardino L, Coluccia C, Aloesio R, Fausone G (1990) Bilary reflux after cholecystectomy. Hepatogastroenterology 37:233–234
Lujan-Mompean JA, Robles-Campos R, Parrilla-Paricio P, Liron-Ruiz R, Torralba-Martinez JA, Cifuentes-Tebar J (1993) Duodenogastric reflux in patients with biliary lithiasis before and after cholecystectomy. Surg Gynecol Obstet 176:116–118
Rees WD, Go VL, Malagelada JR (1979) Simultaneous measurement of antroduodenal motility, gastric emptying and duodenogastric reflux in man. Gut 20:963–970
Ehrlein HG (1981) Gastric and duodenal motility in relation to duodenogastric reflux in dogs. Scand J Gastroenterol 16:23–27
Brough WA, Taylor TV, Torrance HB (1984) The effect of cholecystectomy on duodenogastric reflux in patients with previous ulcer surgery. Scand J Gastroenterol 19 [Suppl 92]:255–256
Svensson JO, Gelin J, Svanvik J (1986) Gallstones, cholecystectomy and duodenogastric reflux of bile acid. Scand J Gastroenterol 21:181–187
Thomas WEG, Cooper MJ, McC NJ, Mortensen PA, Burton, Davies ER (1984) The clinical assessment of duodenogastric reflux by scintigraphy and its relation to histological changes in gastric mucosa. Scand J Gastroenterol 19 [Suppl 92]:195–199
Tytgat CNJ (1992) Endoscopic gastritis and duodenitis. Endoscopy 24:34–40
Dixon MF, O'Connor HJ, Axon ATR, King RFJG, Johnston D (1986) Reflux gastritis: distinct histopathological entity? J Clin Pathol 3:524–530
Mittal BR, Ibrarullah Md, Agarwal DK, Maim A, Ali W, Sikora SS, Das BK, Kaushik SP (1994) Comparative evaluation of scintigraphy and upper gastrointestinal endoscopy for detection of duodenogastric reflux. Ann Nucl Med 8:183–186
de Almedia AM, Cruz AG, Aldeia FJ (1984) Side to side choledochoduodenostomy in management of choledocholithiasis and associated disease — facts and fiction. Am J Surg 147:253–259
Parrilla P, Ramirez P, Bueno FS, Perez Jm, Candel MF, Muelas MS, Robles R (1991) Long term results of choledochoduodenostomy in the treatment of choledocholithiasis: assessment of 225 cases. Br J Surg 78:470–472
Tolin RD, Malmud LS, Stelzer F, Menin R, Makler Jr PJ, Applegate G, Fisher RS (1979) Enterogastric reflux in normal subjects and patients with Billroth II gastroenterostomy — Measurement of enterogastric reflux. Gastroenterology 77:1027–1033
Ritchie Jr WP (1980) Alkaline reflux gastritis: an objective assessment of its diagnosis and treatment. Ann Surg 92:288–298
Ritchie WP (1984) Alkaline reflux gastritis: a critical reappraisal. Gut 25:975–987
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Ali, W., Agarwal, D.K., Sikora, S.S. et al. Duodenogastric reflux after choledochoduodenostomy. Surg Today 27, 247–250 (1997). https://doi.org/10.1007/BF00941654
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF00941654