Duodenogastric reflux following cholecystectomy in the dog: role of antroduodenal motor function

Cholecystectomy and duodenogastric reflux: interacting effects over the gastric mucosa

AIMS

To evaluate association between duodenogastric reflux and early gastric mucosal changes before and after the cholecystectomy procedure.

MATERIALS AND METHODS

Patients were evaluated with preoperative and postoperative endoscopy and endoscopic biopsy. Demographic and clinical characteristics, histological parameters, presence of duodenogastric reflux, and Updated Sydney scores were noted.

RESULTS

A total of fifty patients who obeyed the follow-up were enrolled into the study. Median age of the patients was 43 years (range 25-84). Male-female ratio was 0.51 (17/33). Duodenogastric reflux % and Updated Sydney scores before and after cholecystectomy were 24 (48%) versus 39 (78%) and 2.38 ± 2.21 versus 3.46 ± 3.05, respectively (p = 0.001, p < 0.000). Mucosal inflammation degree showed significant increase in 15 (30%) patients, decrease in 7 (14%) patients and equality in 28 (56%) patients (p = 0.037). Neutrophil activation degree was significantly higher in 21 (42%) patients, lower in 5 (10%) patients after the surgery (p = 0.005). Postoperative glandular atrophy degree was also higher in 13 (26%) patients and equal in 37 (74%) patients (p = 0.001). Pre- and postoperative degree of intestinal metaplasia and H. pylori density did not any show significant difference (p = 0.157, p = 0.248, respectively).There were significant positive correlation between postoperative H. pylori infection and mucosal activity, inflammation, atrophy and intestinal metaplasia.

CONCLUSION

Cholecystectomy is a potent inducer of pathologic duodenogastric reflux. Early onset of duodenogastric reflux and underlying H. pylori gastritis cause early gastric mucosal injury following cholecystectomy procedure by interacting collectively.

Increased Risk of Peptic Ulcers Following a Cholecystectomy for Gallstones

This retrospective cohort study examined the relationship between a cholecystectomy and the subsequent risk of peptic ulcers using a population-based database. Data for this study were retrieved from the Taiwan Longitudinal Health Insurance Database 2005. This study included 5209 patients who had undergone a cholecystectomy for gallstones and 15,627 sex- and age-matched comparison patients. We individually tracked each patient for a 5-year period to identify those who subsequently received a diagnosis of peptic ulcers. We found that of the 20,836 sampled patients, 2033 patients (9.76%) received a diagnosis of peptic ulcers during the 5-year follow-up period: 674 from the study group (12.94% of the patients who underwent a cholecystectomy) and 1359 from the comparison group (8.70% of the comparison patients). The stratified Cox proportional hazard regressions showed that the adjusted hazard ratio (HR) for peptic ulcers during the 5-year follow-up period was 1.48 (95% CI = 1.34~1.64) for patients who underwent a cholecystectomy than comparison patients. Furthermore, the adjusted HRs of gastric ulcers and duodenal ulcers during the 5-year follow-up period were 1.70 and 1.71, respectively, for patients who underwent a cholecystectomy compared to comparison patients. This study demonstrated a relationship between a cholecystectomy and a subsequent diagnosis of peptic ulcers.

The role of bile acids in functional GI disorders

BACKGROUND

Bile acids are increasingly implicated in the pathogenesis of functional GI disorders. New mechanisms have recently been described in the irritable bowel syndrome, chronic diarrhea and chronic idiopathic constipation. Identification of bile acid signaling through farnesoid X receptor (FXR), transmembrane G-coupled receptor 5 (TGR5) and fibroblast growth factor 19 (FGF19) has led to the development of new, directly acting therapeutic agents. Despite these advances primary bile acid diarrhea remains under-recognized partly because of the lack of a widely available diagnostic test.

PURPOSE

In this review we will summarize the effects of bile acids on bowel function throughout the gastrointestinal tract and their roles in the pathogenesis of functional diseases. We will review established diagnostic tests and therapies for functional heartburn, dyspepsia and bile acid diarrhea. There will be a particular emphasis on recent trial data for emerging therapies such as Elobixibat and Obeticholic acid and novel diagnostic tests for bile acid diarrhea such as 7α-Hydroxy-4-cholesten-3-one (C4) and FGF19. Finally we will discuss future directions for research in this rapidly evolving field, such as bacterial bile acid modification and identification of genetic anomalies associated with functional disorders.

Increased prevalence of gallstone disease and impaired gallbladder motility in patients with Barrett's esophagus

The prevalence of gallstones in patients with Barrett's esophagus (BE) and their gallbladder motility relative to that of healthy volunteers and GERD patients without BE were investigated. Of the 707 patients reviewed, 203 (125 males and 78 females) had BE. The prevalence of gallstones was significantly higher in the patients with BE than in those without BE (34 vs. 20%, respectively). The gallbladder functions of 22 patients with GERD, 27 patients with BE and 21 healthy volunteers were assessed by ultrasonography before and after a test meal. The patients with BE had significantly higher fasting volume and residual volume, but lower ejection volume, ejection fraction and ejection rate values than those of the healthy controls. None of the ultrasonographic parameters of patients without BE were significantly different from those of the controls. Patients with BE have a more complex gastrointestinal motility disorder that involves the gallbladder, and this makes this subset of patients with GERD more prone to gallstone disease.

Le reflux biliaire duodéno-gastrique et gastro-œsophagien

This study reviews current data regarding duodenogastric and gastroesophageal bile reflux-pathophysiology, clinical presentation, methods of diagnosis (namely, 24-hour intraluminal bile monitoring) and therapeutic management. Duodenogastric reflux (DGR) consists of retrograde passage of alkaline duodenal contents into the stomach; it may occur due to antroduodenal motility disorder (primary DGR) or may arise following surgical alteration of gastoduodenal anatomy or because of biliary pathology (secondary DGR). Pathologic DGR may generate symptoms of epigastric pain, nausea, and bilious vomiting. In patients with concomitant gastroesophageal reflux, the backwash of duodenal content into the lower esophagus can cause mixed (alkaline and acid) reflux esophagitis, and lead, in turn, to esophageal mucosal damage such as Barrett's metaplasia and adenocarcinoma. The treatment of DGR is difficult, non-specific, and relatively ineffective in controlling symptoms. Proton pump inhibitors decrease the upstream effects of DGR on the esophagus by decreasing the volume of secretions; promotility agents diminish gastric exposure to duodenal secretions by improving gastric emptying. In patients with severe reflux resistant to medical therapy, a duodenal diversion operation such as the duodenal switch procedure may be indicated.