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Postoperative Reflux Gastritis: Pathophysiology and Long-Term Outcome After Roux-en-Y Diversion

JUAN-R. MALAGELADA, M.D.; SIDNEY F. PHILLIPS, M.D.; ROY G. SHORTER, M.D.; JOHN A. HIGGINS, M.D.; CARLOS MAGRINA, M.D.; JONATHAN A. van HEERDEN, M.D.; and MARTIN A. ADSON, M.D.
[+] Article and Author Information

Grant support: in part by grants AM 06908 and RR 585 from the National Institutes of Health. Dr. Malagelada was the recipient of Research Career Development Award AM 00330 from the National Institutes of Health.

▸Requests for reprints should be addressed to Juan-R. Malagelada, M.D.; Gastroenterology Unit, Mayo Clinic; Rochester, MN 55905.


Rochester, Minnesota


© 1985 American College of PhysiciansAmerican College of Physicians


Ann Intern Med. 1985;103(2):178-183. doi:10.7326/0003-4819-103-2-178
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Sixteen patients with clinical features of postoperative gastritis who had been advised to have a Roux-en-Y diversion were studied prospectively. Studies were done pre- and postoperatively (mean follow-up, 4.9 years; range, 3.8 to 6.9), and the findings were compared with those in 11 control subjects with previous enterogastric anastomosis but with no symptoms. The patients had higher concentrations of bile acids and trypsin in gastric samples than did controls. Patients had greater endoscopic changes, although mucosal histologic characteristics were similar in both groups. Administration of aluminum hydroxide or cholestyramine reduced the aqueous concentrations of bile acids in gastric contents. Roux-en-Y diversion virtually eliminated duodenogastric reflux, and gastroscopic appearances returned to normal. However, Roux-en-Y diversion did not change mucosal histologic characteristics. Symptom scores were reduced in the early postoperative period, but bilious vomiting was the only symptom alleviated consistently and permanently. As a treatment for postoperative gastritis, Roux-en-Y diversion offers potential but limited benefits.

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