Duodeno-Gastric reflux before and after cholecystectomy

ABSTRACT

Duodenogastric reflux [DGR] has been suggested as an etiopathogenic factor in persisted of dyspeptic symptomes after cholycystectomy in some patients with gall stones disease. We evaluated the DGR in 10 gall stones diseased patients before and after simple. Cholecystectomy, in addition to 10 individuals with no oesophageal, gastric, duodenal, bilirary or pancreatic disease, but undewent any form of elective abdominal surgery other than gastric or biliary surgery taken as a control group. Their symptoms, gastric pH total and individual bile acids concentrations in fasting gastric juice and their refluxes were evaluated one day before and fifteen days after surgery. Gastric juice was obtained under fasting conditions by continuous nasogastric suction for a period of time extended from 10 hours in some subjects up to 24 hours in others. The total bile acids present in the samples were extracted by organic solvents and individual bile acids were fractionated and separated by thin-layer chromatography, then total and individual bile acids were quantified colorimetrically by the method described by Mashige et al., [1981]. Before Cholecystectomy, Right hypochondrium pain and biliary colic were present in 7 patients [70%] and dyspepsia in the form of heart burn, nausea, vomiting and flatulence with varying degrees in 8 patients [80%]. After surgery, biliary colic disappeared in all patients. Dyspeptic symptoms improved in 7 patients [70%], 3 patients [30%] remained with dyspeptic symptoms in the form of heart burn and flatutulence. The gastric pH was statistically highly significantly increased from 3.26 +/- 0.636 to 5.73 +/- 1.246 after Cholecystectomy, the total bile acids concentrations in fasting gastric juices were statistically highly significantly increased from 229.84 +/- 92.16 to 461.8 +/- 202.3 umol/l also the total bile acids refluxed per hours increased from 9.8 +/- 4.7 to 33.5 +/- 21.4 umol/h after, Cholecystectomy. Also, the studied individual bile acids and their refluxes per hours were statistically significantly increased after Cholecystectomy as follow; Glycocholic a. from 58 +/- 33.8 to 207.5 +/- 118.1 umol/l, Taurocholic a. from 95.5 +/- 55.9 to 100.5 +/- 47.4 umol/l Cholic a. from 10.9 +/- 15.06 to 38.5 +/- 37.6 umol/l, Lithocholic a. from 6.8 +/- 2.10 to 47.9 +/- 36.735 umol/l, also, their refluxes increased as follow; Glycocholic a. refluxed/h from 2.48 +/- 1.49 to 11.37 +/- 6.7 umol/h, Taurocholic a refluxed/h from 3.95 +/- 2.46 to 5.495 +/- 2.832 umol/h Cholic a. refluxed/h from 0.57 +/- 0.75 to 2.093 +/- 2.0921 umol/h and Lithocholic a. refluxed/h from 0.28 +/- 0.08 to 2.608 +/- 2.021 umol/h. The study showed no any statistically significant change in DGR between patients with or without dyspeptic symptoms after Cholecystectomy. Thus, inspite of occurrence and increase of DGR in all patients after Cholecystectomy we can not attribute the persistence of dyspeptic symptoms in some patients after surgery to DGR or to the changes of individual bile acids alone but may be to multiple factors as there is no any significant change in DGR between the patients with or without dyspeptic symptoms after surgery