Pathophysiologic findings of bile reflux gastritis. How is it managed?
Bile reflux gastritis occurs when ablation or dysfunction of the pylorus results in stasis of bile in the stomach. The diagnosis is made with the following triad of findings:
- A. Postprandial epigastric pain accompanied by nausea and bilious emesis
- B. Evidence of bile reflux into the stomach or gastric remnant
- C. Biopsy-proved gastritis
Bile reflux gastritis can occur after truncal vagotomy and pyloroplasty or truncal vagotomy and antrectomy with Billroth reconstruction.
Although up to 20% of patients who undergo these operations may have transient bile reflux gastritis postoperatively, symptoms resolve in all but 1% to 2%.
Treatment of bile reflux gastritis requires revision of the pyloroplasty or the Billroth reconstruction to a Roux-en-Y gastrojejunostomy with a 50- to 60-cm limb.
Bilious emesis resolves in nearly 100% of patients who undergo revision. The symptoms of bile reflux gastritis may be indistinguishable from those of gastroparesis.
Because the Roux-en-Y gastrojejunostomy worsens the symptoms of gastroparesis, care must be taken to exclude the diagnosis of gastroparesis preoperatively.