Duodenogastric reflux and gastric mucosal polyamines in the non-operated stomach and in the gastric remnant after Billroth II gastric resection. A role in gastric carcinogenesis?

Background. The relationship between bile reflux and gastric cancer is not defined. In order to verify, whether a relationship exists, we evaluated th e duodenogastric reflux and the mucosal polyamines concentration, polycatio n compounds actively involved in cell proliferation, in the nonoperated sto mach and in gastric remnant after Billroth II gastric resection, a precance rous condition. Materials and Methods. The study was performed on three gro ups of subjects: A) 43 subjects with slight dispeptic symptoms, never opera ted on; B) 54 cholecystectomized subjects; C) 38 subjects operated on Billr oth II gastric resection for duodenal ulcer. Duodenogastric reflux was asse ssed by measuring the concentration of bile acids in gastric juice and expr essed as Fasting Bile Reflux in micromol/hour. Gastric mucosal polyamine co ncentration was assessed by High Performance Liquid Chromatography and expr essed in nmol/mg of proteins. Results. The lowest levels of Fasting Bile Re flux (7.95 micromol/hour) and polyamines (7.09 nmol/mg proteins) were obser ved in subjects never operated on. The middle values were present after cho lecystectomy (Fasting Bile Reflux = 18 micromol / hour; polyamines = 8.14 n mol/mg proteins). The highest values were observed after Billroth II gastri c resection (Fasting Bile Reflux = 830 micromol/hour; polyamines 11.74 nmol /mg proteins) (Kruskal-Wallis test, p = 0.0001). There was a positive corre lation between Fasting Bile Reflux and polyamines (Spearman's rank = 0.33; p=0.0008). Conclusions. High levels of duodenogastric reflux observed after Billroth II gastric resection are associated with high polyamine concentra tion in the gastric mucosa. Bile reflux can be considered an important caus al factor of the increased risk of gastric stump cancer after Billroth II g astric resection.