DUODENOGASTRIC REFLUX, HISTOLOGY AND CELL-PROLIFERATION OF THE GASTRIC-MUCOSA BEFORE AND 6 MONTHS AFTER CHOLECYSTECTOMY

In order to evaluate the effects that an increase in duodenogastric re flux (DGR) has on the mucosal cell proliferation of the non-operated s tomach, we made a prospective study on 13 patients (9 female and 4 mal e, mean age 52 years) both before and 6 months after cholecystectomy, an operation which determines a significant increase in DGR with an in tact pyloric sphincter. DGR was evaluated by measuring total intragast ric bile acids (dosed by an enzymatic method), and single intragastric bile acids (dosed by High Performance Liquid Chromatography) and it w as expressed as Pasting Bile Reflux (FBR) in mu mol/h. Gastric cell pr oliferation was evaluated by measuring (by High Performance Liquid Chr omatography) polyamine (putrescine, spermidine and spermine) levels in biopsy specimens taken from the antrum and gastric body. The histolog y of the antrum and gastric body was also evaluated, After cholecystec tomy, there was a significant increase in DGR (Delta=39,23 mu mol/h, 9 5% C.L. 11.69-136.22, sign-test for matched pairs p=0.0003). The tissu e concentration of putrescine in the antrum increased significantly (D elta=8.36 mu mol/g of tissue, 95% C.L. 0.34-18.01, sign-test for match ed pairs p=0.013) and there was a worsening of histological findings i n the antrum (preoperative chronic atrophic gastritis rate 38.5 %, pos toperative 69%). In the body there were no significant variations eith er in polyamine levels or in histology, The increase in DGR and in put rescine concentrations in the antrum were associated negatively (Spear man's rank -0.64, 95% C.L. -0.88 to -0.14). Our data would show that a n increase in DGR with an intact pyloric sphincter, as occurs after ch olecystectomy, does not directly stimulate gastric mucosal cell prolif eration.