Study on 82 gastritis patients (19-63 years old), in which 40 patients had endoscopic features of duodenogastric reflux and 42 had no endoscopic of duodenogastric reflux, were treated at 19.8 Hospital from December 2000 to October 2001. All subjects were assessed of gastric mucosa's damages in endoscopy and histology as well as Helicobacter pylori infection rate. The results: the rate of patients were infected with H.pylori significantly fewer than in group without duodenogastric reflux. The rate of H.pylori infection in mild duodenogastric reflux patients was significantly higher than the rate in moderate and severe duodenogastric reflux patients. In patients with both factors (duodenogastric reflux and H.pylori infection), chronic atrophic gastritis' rate was significantly higher compared with the rate of patients who had only one factor or non of both. In patients with duodenogastric reflux but without H.pylori infection: simply chronic gastritis' rate was significantly lower and chronic atrophic gastritis' rate was higher than group without duodenogastric reflux
Helicobacter pylori ; Gastritis ; Duodenogastric Reflux

PURPOSE: Billroth I and II reconstructions are commonly performed after a distal subtotal gastrectomy. However, both may cause duodenogastric and duodenogastroesophageal reflux, which are conditions reported to have carcinogenic potential. This study investigated which reconstructive procedure would be most effective in prevent bile reflux into the gastric remnant after a distal gastrectomy. METHODS: A group of 43 patients who underwent a curative distal gastrectomy for gastric cancer were assigned to three groups prospectively according to the reconstructive procedure undertaken: 14, Billroth I (B-I); 14, Billroth II with Braun anastomosis (B-II with Braun); and 15 Billroth II (B-II). The bile reflux period (percent time) for the gastric remnant was measured using a Bilitec 2000 under standardized conditions. The endoscopic findings for reflux gastritis were classified into four grades. RESULTS: The mean standard error time of bile reflux in B-I, B-II with Braun and the B-II groups was 30.9+/-3.9%, 32.8+/-5.1% , and 60.9+/-7.0%, respectively. The B-II group showed significantly higher levels of the % time of bile reflux than the B-I or B-II with Braun groups (P<0.001). Regarding the endoscopic classification for reflux gastritis, the remnant stomach after B-II showed significantly more severe and extensive gastritis than that after the B-I and B-II with Braun procedures (P=0.003). There was also a positive correlation between the degree of % time of bile reflux and the extent of gastritis in the gastric remnant (P<0.001). CONCLUSION: After a distal subtotal gastrectomy, a B-II reconstruction is associated with a high reflux of duodenal content, whereas a Braun enteroenterostomy after a B-II reconstruction minimized the reflux at the levels of a B-I reconstruction.
Bile Reflux ; Classification ; Duodenogastric Reflux* ; Gastrectomy* ; Gastric Stump ; Gastritis ; Gastroenterostomy ; Humans ; Prospective Studies ; Stomach Neoplasms

BACKGROUND/AIMS: It is suggested that postsurgical gastritis is mainly caused by the enterogastric reflux, but the pathogenesis and association with symptoms are not clearly established. The aims of this study were to investigate the role of duodenogastric reflux in postsurgical gastritis and to evaluate the relationship between an intragastric pH study and an intragastric bile reflux study. METHODS: The 33 patients with Billroth-II gastrectomy and 10 healthy volunteers were enrolled. After the endoscopy, we performed a simultaneous intragastric pH and a bile reflux study. RESULTS: The symptomatic patients with Billroth-II gastrectomy showed a greater increase in bilirubin reflux than the asymptomatic patients and normal controls. There was a significant association of gastritis with the presence of symptoms, but not with duodenogastric reflux. Intragastric bile reflux(% time> bilirubin absorbance 0.14) was not closely related with intragastric pH(% time> pH 4). CONCLUSIONS: The duodenogastric reflux was associated with symptoms but not with postsurgical gastritis. There was no close relationship between the intragastric pH study and the intragastric bile reflux study.
Bile ; Bile Reflux ; Bilirubin ; Duodenogastric Reflux* ; Endoscopy ; Gastrectomy* ; Gastritis* ; Healthy Volunteers ; Humans ; Hydrogen-Ion Concentration

BACKGROUND/AIMS: The role of Helicobacter pylori in bile reflux gastritis (BRG) is uncertain. We show the role of H. pylori and pathology in BRG. METHODS: Thirty seven patients, including 5 patients who had undergone subtotal gastrectomy, were diagnosed with BRG by gastroscopic findings of bile-stained mucosa with hyperemia/ erosions. We measured total bile acid (TBA) concentration and compared the H. pylori positivity between BRG patients and 70 non-BRG patients. We showed how often we could see the pathologic findings of reactive gastritis in BRG and compared the grade of lymphoplasma cell and neutrophil infiltration between H. pylori positive and negative group in BRG. RESULTS: TBA concentration of 10 patients was 7,376.7+/-5,482.6micro mol/L. H. pylori positive rate of BRG was 45.9% and that of non-BRG was 70% (p=0.015). The gastric pit elongation and tortuosity were found only in 3 cases with gastric surgery. The grade of lymphoplasma cell and neutrophil infiltration was 2.41+/-0.51 and 1.88+/-0.86 in H. pylori positive BRG and 1.55+/-0.69 and 0.55+/-0.76 in H. pylori negative BRG, respectively (p<0.001). CONCLUSIONS: H. pylori infection in BRG was lower than that in non-BRG. The gastric pit elongation and tortuosity of BRG were not seen often. The lymphoplasma cell and neutrophil infiltration were relatively sparse in H. pylori negative BRG.
Bile Reflux* ; Bile* ; Duodenogastric Reflux ; Gastrectomy ; Gastritis* ; Helicobacter pylori* ; Helicobacter* ; Humans ; Mucous Membrane ; Neutrophil Infiltration ; Pathology

Bilirubin ; Child ; Duodenogastric Reflux ; diagnosis ; Esophageal Diseases ; diagnosis ; Esophagus ; metabolism ; Gastroesophageal Reflux ; diagnosis ; Humans

OBJECTIVETo explore the effect of bile in inducing gastric mucosal injury in rats.

METHODSSD rats were divided into 4 groups, namely bile duct ligation group, duodenogastric reflux (DGR) group, DGR plus bile duct ligation group and normal control group. The pathological changes in the gastric mucosa and tight junction 3 months after gastrojejunostomy were observed and compared with the findings in the normal control rats.

RESULTSCompared with the rats in DGR plus bile duct ligation group, the rats in DGR group showed obvious gastric mucosal hyperemia, foveolar hyperplasia and severely impaired tight junction between the gastric mucosal cells.

CONCLUSIONBile plays an important role in gastric mucosal injury due to DGR.

Animals ; Bile ; physiology ; Duodenogastric Reflux ; physiopathology ; Gap Junctions ; pathology ; Gastric Mucosa ; pathology ; Male ; Random Allocation ; Rats ; Rats, Sprague-Dawley

The role of duodenal reflux and the time required for the development of Barrett's esophagus has remained controversial. We report a case of Barrett's esophagus that developed 6 months after total gastrectomy. A 76-year-old man diagnosed with gastric adenocarcinoma underwent a total gastrectomy and a Rouxen-Y esophagojejunostomy. The gastroesophageal junction in the resected specimen was both grossly and microscopically normal at the time of the operation. A routine follow-up endoscopic examination performed 6 months later revealed a tongue-like projection of redcolored columnar tissue. No reflux symptoms (heartburn or acid regurgitation) had been present during the intervening 6 months. A biopsy specimen from the esophagus showed intestinal-type metaplasia of the columnar epithelium. This case supports the development of Barrett's esophagus solely from duodenal reflux and after a relatively short time in this clinical setting.
Adenocarcinoma ; Aged ; Barrett Esophagus ; Biopsy ; Duodenogastric Reflux ; Epithelium ; Esophagogastric Junction ; Esophagus ; Follow-Up Studies ; Gastrectomy ; Humans ; Metaplasia

Adolescent ; Bilirubin ; metabolism ; Child ; Child, Preschool ; Duodenogastric Reflux ; metabolism ; Esophageal pH Monitoring ; Female ; Humans ; Male ; Stomach ; physiopathology

OBJECTIVEDuodenogastric reflux (DGR) is a reverse flow of duodenal juice into stomach through pylorus composed of bile acid, pancreatic secretion, and intestinal secretion. The increased entero-gastric reflux results in mucosal injury that may relate not only to reflux gastritis but also esophagitis, gastric ulcers, carcinoma of stomach and esophagus. However, the exact mechanisms of gastric mucosal damage caused by DGR are still unknown. The objective of the present study is to investigate the pathogenic effect of primary DGR on gastric mucosa in children, and to explore the correlation of DGR with clinical symptoms, Hp infection and intragastric acidity.

METHODTotally 81 patients with upper gastrointestinal manifestations were enrolled and they were graded according to the symptom scores and underwent endoscopic, histological examinations and 24-hour intra-gastric bilirubin was monitored with Bilitec 2000. Of the 81 cases, 51 underwent the 24-hour intra-gastric pH monitoring by ambulatory pH recorder simultaneously. The total fraction time of bile reflux was considered as a marker to evaluate the severity of DGR. The total fraction time of bile reflux was compared between the patients with positive and negative results under endoscopy and histologically, respectively. The correlations of the total fraction time of bile reflux with clinical symptom score, Hp infection, intragastric acidity were analyzed respectively.

RESULTThe total fraction time of bile reflux in the patients with hyperemia and yellow stain gastric antral mucosa under endoscopy was significantly higher than that without those changes [17.1% (0.5% approximately 53.2%) vs. 6.5% (0 approximately 58.6%), Z = -1.980, P < 0.05; 19.8% (0.5% approximately 58.6%) vs. 8.8% (0 approximately 38.0%), Z = -2.956, P < 0.01 respectively]. Histologically, the cases with intestinal metaplasia had significantly higher total fraction time of bile reflux than in the cases without intestinal metaplasia [29.0% (1.9% approximately 58.6%) vs. 14.3% (0 approximately 53.7%), Z = -2.026, P < 0.05], but no significant difference was found either between the cases with and without chronic inflammation (P > 0.05) or between the cases with and without active inflammation (P > 0.05). The severity of bile reflux was positively correlated with the score of abdominal distention (r = 0.258, P < 0.05), but no correlation with either the severity of intragastric acid (r = -0.124, P > 0.05), or Hp infection (r = 0.016, P > 0.05) was found.

CONCLUSIONPrimary DGR could cause gastric mucosal lesions manifested mainly as hyperemia and bile-stained gastric antral mucosa under endoscopy and the gastric antral intestinal metaplasia histologically in children. There was no significant correlation between DGR and gastric mucosal inflammatory infiltration. DGR had no relevance to Hp infection and intragastric acidity. We conclude that DGR is probably an independent etiological factor and might play a synergistic role in the pathogenesis of gastric mucosal lesions along with gastric acid and Hp infection.

Adolescent ; Bile Reflux ; pathology ; physiopathology ; Child ; Child, Preschool ; Duodenogastric Reflux ; microbiology ; pathology ; physiopathology ; Female ; Gastric Mucosa ; microbiology ; pathology ; Helicobacter Infections ; Helicobacter pylori ; Humans ; Hydrogen-Ion Concentration ; Male

Xanthoma is characterized by collections in the lamina propria of lipid-laden macrophages or foam cells containing cholesterol land neutral fat, forming plagues or nodules in all regions of the gastrointestinal tract. But it is most common in the stomach. Once thought to be a rare entity, gastric xantoma has been reported with increasing frequency with the advent of increasing utilization of gastrofiberscopy. Because gastric xanthoma appear to be more common in patients with gasritis, gastric ulcer, and with duodenogastric reflux after gastric surgery, mucosal damage has been presumed to play a major role in their pathogenesis. Altough cholesterol and neutral fat are the major constituents of the foam cells, there is no documented relationship between degree of hyperlipidemia or hypercholesterolmia and presence of gastric xanthoma. Gastric xanthoma may be found in any portion of the stomach, and is single or multiple, usually 1 or 2 mm in diameter, rounded or oval, circumscribed, yellow or yeallow-white, and macular or nodular. We report a case of gastric xanthomatosis diagnosed by gastrofibroscopy with forceps biopsy. There are numerous, flat or slightly raised, white or yellow white lesions that range from pinpoint size to several milimeters in diameter and that are scattered through whole gastric mucosa.
Biopsy ; Cholesterol ; Duodenogastric Reflux ; Foam Cells ; Gastric Mucosa* ; Gastrointestinal Tract ; Humans ; Hyperlipidemias ; Macrophages ; Mucous Membrane ; Stomach ; Stomach Ulcer ; Surgical Instruments ; Xanthomatosis*