ABSTRACT
Evaluation of the problem of enterogastric reflux in duodenal ulcer patients managed by anterior and posterior truncal vagotomy and simple loop gastrojejunostorny. Between September 1976 and May 1996, 709 duodenal ulcer patients were managed by different surgical techniques. Anterior and posterior truncal vagotomy with simple loop gastrojejunostomy were done for 372 patients [52.5%]. Of the last group, 75 random patients were studied for enterogastric reflux. The mean postoperative period was 6.5 years, the mean age was 43 years, 64 were men and 11 were women. Careful clinical examination, barium meal study and esophagogastroscopy with histological examination of multiple gastric biopsies were done for all patients. Dual channel simultaneous esophageal and gastric 24h pH monitoring was done for 28 patients. Patients were classified into 2 groups, group 1 included 44 patients [58.7%] free of symptoms and group 2 included 30 patients [40%] who complained of one or more symptom of gastritis, however, the classic symptoms of alkaline refiux gastritis were found only in 8 patients [10.7%]. One patient [1.3%] was excluded due to proved ulcer recurrence. Endoscopic evidence of gastritis was found in 50% in group I versus 73.3% in group 2 [P<0.05]. Histopathologic evidence of gastritis was found in 77.3% in group 1 versus 46.7% in group 2 [P=0.007]. PH monitoring revealed alkaline gastric reflux in 50% in group I versus 75% in group 2 [P>0.05] alkaline esophageal reflux in 33.3% in group 1 versus 50% in group 2 [P<0.05] and mixed esophageal reflux [i.e alkaline and acidic] in 16.7% in group 1 versus 18.8% in group 2 [P> 0.05]. Enterogastric refiux is not an infrequent problem after trurcal vagotomy and loop gas trogejunostory. Pathologic alkaline gastric reflux should be proved by endoscopy, histopathology and pH metry before deciding remedial surgery