DUODENOGASTRIC REFLUX AND GASTRIC-MUCOSAL CELL-PROLIFERATION AFTER CHOLECYSTECTOMY OR BILLROTH-II GASTRIC RESECTION

Objectives and methods. - Twelve patients to be undergone cholecystect omy and 4 patients to be undergone Billroth II gastric resection were examined before and after surgery in order to evaluate the association between duodenogastric reflux and gastric mucosal cell proliferation. Duodenogastric reflux was assessed by measuring the concentration of bile acids in gastric juice and expressed as fasting bile reflux in mu mol/h. Gastric mucosal cell proliferation was assessed by measuring t he concentration of polyamines (putrescine, spermidine and spermine) i n biopsy specimens and expressed in mu mol/g of tissue. Results. - The median increase in fasting bile reflux was 34 mu mol/h after cholecys tectomy and 238 mu mol/h after Billroth II gastric resection (P = 0.00 8). After cholecystectomy the median value of putrescine levels in ant rum was 39 mu mol/g, whereas after Billroth II gastric resection putre scine levels in pre-anastomotic area was 79.5 mu mol/g (P = 0.008). Th ere was a positive correlation between fasting bile reflux and putresc ine levels either in antrum (P = 0.37, P = 0.04) or body (r = 0.48, P = 0.006). Conclusions. - The increase in cell proliferation activity o f gastric mucosa after Billroth II gastric resection might explain the increased risk for cancer of gastric remnant.