Bile Reflux Gastritis

Intractable epigastric pain associated with nausea and bilious vomiting often follows gastric surgery and has been attributed to the reflux of alkaline bile and its irritating effects on the gastric mucosa. Bile reflux may occur either thru an incompetent pylorus or through the surgical afferent limb into the gastric remnant.

Factors contributing to primary bile reflux gastritis:

• Pyloric insufficiency is necessary to allow continuing influx of bile-containing duodenal contents.

• Delayed gastric emptying may allow prolonged contact of the bile salts and the gastric mucosa.

• Bile secretion is more continuous in patients who have previously undergone cholecystectomy, and the larger volume of duodenal bile may encourage reflux.

• Billroth II procedure

Management of this condition has involved the use of various pharmacologic treatments including bile-acid binding agents and sucralfate. Surgical management is achieved by diverting bile flow through a Roux-en-Y choledochojejunostomy.