Incidence of bile reflux in gastric ulcer and after partial gastrectomy

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Abstract
Duodenogastric bile reflux (DGBR) is reported to be increased in patients with gastric ulcer (GU) and following Billroth I partial gastrectomy (BIPG). pH, total bacterial counts, and total and free bile acids were measured in gastric juice aspirated hourly for 24 h in 6 patients with GU, 7 patients with a BIPG performed for GU and in 8 healthy normal controls. Intragastric pH was significantly higher in the BI PG group during the day (P < 0·001) and at night (P < 0·001) compared with normals and the GU group. There were no differences between GUs and normal patients. Bile acid concentrations in the gastric juice were not significantly different between GU and control groups over the 24 h. Median and range values were 0·14 (0·06–0·52) mmol l−1 in GU patients and 0·14 (0·05–0·67) mmol l−1 in the normals. However total bile acid concentrations were significantly greater in the BIPG group (0·23, 0·04–0·84) compared with GU or controls. (P = 0·04, P = 0·02). Our data do not support the role of DGBR in the pathogenesis of GU, but deoxycholic acid was detected in significantly greater amounts in BIPG subjects than controls (χ2 = 12·94, P <0·001) or GU subjects (none detected) and may be important in the pathogenesis of gastric stump cancer.