Four of a series of 40 patients who underwent the Nissen fundoplication to correct reflux oesophagitis developed gastric ulceration 24, 22, 15 and 13 months respectively after the procedure. The gastric ulceration is attributed to bile reflux, and the original oesophagitis to "alkaline" reflux. When severe oesophagitis results from "alkaline" reflux, a Roux-en-Y bile diversion operation with vagotomy and fundoplication should be considered.