PATHOLOGICAL DUODENOGASTRIC REFLUX ASSOCIATED WITH PERSISTENCE OF SYMPTOMS AFTER CHOLECYSTECTOMY

Background. The aim of this study was to determine whether increased d uodenogastric reflux contributes to postcholecystectomy symptoms. Meth ods. Gastric pH monitoring, hepatobiliary scintigraphy, gastric emptyi ng scans, and gastric acid analysis were performed in asymptomatic (n = 10) and in symptomatic (n = 27) patients after cholecystectomy. Norm al subjects (n = 20), patients with dyspepsia related to gastric acid hypersecretion (n = 20), patients with reflux gastritis after gastric surgery (n = 10), and patients with confirmed primary pathologic duode nogastric reflux (n = 10) were studied as controls. Symptomatic patien ts also underwent upper gastrointestinal endoscopy. Results. Symptomat ic patients had significantly increased interprandial gastric exposure to pH <3 compared with asymptomatic subjects, which correlated well w ith a high incidence of hepatobiliary scans positive for abnormal duod enogastric reflux and chronic gastritis on endoscopy. Gastric alkaline exposure in symptomatic patients was similar to that seen in patients with primary pathologic duodenogastric reflux and patients with duode nogastric reflux related to gastric surgery. Gastric acid secretion an d gastric emptying were not altered. Five patients tested before and a fter laparoscopic cholecystectomy showed that nocturnal gastric alkali zation was enhanced after operation. Conclusions. This study suggests that excessive duodenogastric reflux may be responsible for persistenc e of symptoms after cholecystectomy.