Primary bile reflux gastritis: Which treatment is better, Roux-en-Y or biliary diversion?

Primary bile reflux gastritis is an unusual and elusive problem. Postgastre ctomy bile reflux has been long recognized and treated variously with Roux- en-Y gastrojejunostomy, Braun enteroenterostomy, and Henley jejunal interpo sition. All of these procedures have been fraught with postoperative side e ffects, the worst of which is stasis. A new procedure utilizing biliary div ersion has been proposed to divert bile from the gastric lumen without vago tomy or gastric resection. This procedure was used for 16 patients with dia gnosed bile reflux, and results were compared with those of a previous grou p of 21 patients who had been treated with Roux-en-Y gastrojejunostomy. The patient groups were similar in age, sex, weight, symptoms, and results of investigative studies. The earlier group all had vagotomy, antrectomy, and gastrojejunal anastomosis to a 45-cm Roux limb. The later group all had an end-to-side choledochojejunostomy to a 45-cm Roux limb, taken 45 cm from th e ligament of Treitz. The patients in the bile diversion group had fewer co mplications and shorter hospital stays. In addition, they had few postopera tive complaints, no further operations for either bile reflux or upper gast rointestinal stasis, and no long-term deaths due to gastrointestinal proble ms or malnutrition. Their eventual postoperative gastric emptying improved significantly when compared with the Roux-en-Y patients, suggesting that th e dysmotility observed preoperatively may well have been a result of the bi le injury to the stomach, rather than an underlying gastric dysmotility.