Upper Gastrointestinal Surgery Unit

DUODENOGASTRIC REFLUX

Many patients complain of gastric symptoms such as nausea, epigastric pain or fullness, or bilious vomiting. Some gastritis may be present on endoscopic examination of the gastric mucosa or in gastric biopsy samples.

These symptoms may be multifactorial in origin, relating to delayed gastric emptying,Helicobacter pylori antral infection, or impaired fundic relaxation.

In a subset of patients, gastric symptoms are due to pathologic exposure of the gastric mucosa to duodenal juice.

The best way to assess the implication of duodeno-gastric reflux in the genesis of gastric symptoms and mucosal inflammation is to perform an intragastric bilimetry with the Bilitec 2000, an optoelectronic device capable of monitoring the presence of bile in the upper gastro-intestinal lumen over a 24-hour period

   

First-line therapy in patients with duodeno-gastric reflux symptoms and lesions includes proton pump inhibitors and gastric prokinetics.

Some highly selected patients with pathologic exposure of the gastric mucosa to bile documented by intragastric bilimetry, without HP antral infection, and in whom disabing gastric symptoms persist despite optimal medical treatment may be considered for a duodenal switch operation. This bile diverting procedure normalizes gastric exposure to bile in all the operated patients and alleviates related gastric symptoms in most of them.