bile reflux gastritis
Introduction
Introduction to bile reflux gastritis Bile reflux gastritis, also known as spastic reflux gastritis, refers to a series of manifestations of upper abdominal pain, vomiting bile, bloating, weight loss caused by bile reflux into the stomach, common in gastrectomy, gastrointestinal After anastomosis, the total incidence rate is about 5%, and the incidence of Billroth II gastrectomy is 2 to 3 times that of Billroth I. In view of its symptoms, pathological changes, and treatment response and other post-gastric resection syndromes. In contrast, Roberts et al. classified the disease from complications after gastrectomy and classified it as an independent disease. basic knowledge The proportion of illness: 0.12% Susceptible people: no specific population Mode of infection: non-infectious Complications: esophagitis gastric ulcer
Cause
Causes of bile reflux gastritis
The pylorus is incomplete (25%):
The occurrence of this syndrome must first have the basic conditions of pyloric function loss or pyloric insufficiency. For example, after gastric resection or gastrointestinal anastomosis, bile can directly flow back into the stomach; some patients have no history of surgery, duodenum content The substance can be returned to the stomach through the closed pylorus, causing reflux gastritis. After the cholecystectomy, the function of storing bile is lost, and the bile continues to flow into the duodenum. If the pylorus is closed, it can flow back into the stomach. Fluid gastritis. Gastrin can stimulate the proliferation of gastric mucosal cells to strengthen its barrier and prevent the reverse dispersion of H+, but the gastrin secretion is reduced by about 50-75% after Billroth II gastrectomy, which may be an important cause of this syndrome. one.
After gastrectomy (30%):
Biliary reflux into the stomach after gastrectomy is a common phenomenon, but not every person has symptoms, the cause of which may be related to the following factors: 1 gastric emptying disorder reflux fluid in the stomach for a long time, pH rise, Aerobic bacteria and anaerobic bacteria in the residual stomach are more likely to grow. These bacteria can cause the bile salts to liberate and cause inflammation of the gastric mucosa, thus causing symptoms; 2 changes in bile acid composition Gadacz found that normal bile acid components do not develop symptoms, but deoxycholic Symptoms of acid increase are often symptomatic; 3 There are bacteria in the gastric juice, there are Gram-negative bacilli or Pseudomonas in the gastric juice of patients with symptoms, the use of doxycycline can alleviate the symptoms; and asymptomatic people have no gastric juice Bacteria exist; 4 sodium concentration in gastric juice exceeds 15mmol / L is prone to gastritis, while sodium concentration below 15mmol / L is no gastritis.
Helicobacter pylori infection (25%):
Helicobacter pylori infection causes inflammation of the gastric mucosa, and bile reflux gastritis can coexist with HP infection. Both HP infection and bile reflux are associated with mucosal damage, which may affect the gastroduodenum by increasing gastrin release. Power, causing bile reflux.
Other reasons (20%):
For example, primary pyloric sphincter dysfunction can prolong pyloric opening time, pyloric relaxation or sputum continuous open state, so that duodenal contents flow back into the stomach, causing duodenogastric reflux; such as gastrointestinal neuropeptides and Abnormal hormonal levels can lead to disturbances in gastrointestinal motility leading to duodenogastric reflux.
Prevention
Bile reflux gastritis prevention
1. Diet: pay attention to a small number of meals, eat a low-fat diet, can reduce the frequency of reflux symptoms after eating, on the contrary, high-fat diet can promote the secretion of cholecystokinin in the small intestinal mucosa, easily lead to reflux of gastrointestinal contents.
2. Weight: Those who are overweight should lose weight, because the abdominal pressure of obese people is increased, which can promote gastric reflux, especially in the supine position, so it should actively reduce weight to improve reflux symptoms.
3. Lying position: The bed head is 15-20cm high, which is a good way to reduce the reflux of gastric juice at night.
Complication
Complications of bile reflux gastritis Complications esophagitis gastric ulcer
In addition to complications such as esophageal stricture, hemorrhage, ulcer, etc., the reflux of gastric juice can also erode the pharynx, vocal cords and trachea and cause chronic pharyngitis, chronic vocal corditis and bronchitis, clinically known as Delahunty syndrome, gastric juice Reflux and inhalation of the respiratory tract can cause aspiration pneumonia.
Symptom
Bile reflux gastritis symptoms common symptoms nausea bloating weight loss middle and upper abdominal pain weight loss nausea and vomiting diarrhea bile reflux bile retention
Most patients complain of persistent burning pain in the upper abdomen, increased pain after meals, can not be relieved after taking drugs, or increase the drama, a small number of patients can show post-sternal pain, or stomach indigestion, bilious vomiting Is a characteristic manifestation, due to gastric emptying disorders, vomiting occurs in the evening or midnight, vomit can be accompanied by food, occasionally a small amount of blood, because of fear of increased symptoms after eating, patients reduce food intake, can occur anemia, weight loss , malnutrition and diarrhea and other performances.
Examine
Examination of bile reflux gastritis
(1) Endoscopy can directly see bile reflux, gastric mucosa congestion, edema, or erosion, biopsy suggests gastritis, although bile reflux is a common condition after gastrectomy, such as gastroscopy shows atrophy Gastritis, bile reflux gastritis can be diagnosed.
(2) Determination of gastric aspirate after gastric tube insertion, aspiration of fasting and postprandial gastric juice, determination of cholic acid content, such as fasting basic gastric acid secretion (BAO) <3.5mmol / h, bile acid more than 30g / ml, then Diagnosis of bile reflux gastritis.
(III) Isotope determination: intravenous injection of 2mCi99mTc-butylimine diacetate, observe the liver and biliary tract for 1 hour every 5 minutes, 1 hour patient drink 100ml water, containing 0.3mCi99mTc, to accurately determine the position of the stomach, then Within 2 hours, check the liver, gallbladder and stomach area every 15 minutes, determine the gastrointestinal reflux index, the normal value is 8.6 ± 6.0; the reflux gastritis increased to 86.3 ± 7.1, can also be injected into the twelve fingers with 99mTc labeled solution In the upper part of the intestine or jejunum, then the content of isotopes in the stomach is traced to understand the extent of gastrointestinal reflux.
Diagnosis
Diagnosis and diagnosis of bile reflux gastritis
Can be diagnosed based on clinical performance and laboratory tests.
It should be differentiated from reflux esophagitis, peptic ulcer, angina pectoris, esophageal cancer and esophageal fungal infection.
Reflux esophagitis (RE) is an esophageal inflammatory lesion caused by the stomach and duodenal contents flowing back into the esophagus. Endoscopically, it is a lesion of the esophageal mucosa, that is, esophageal erosion and/or esophageal ulcer. Reflux esophagitis can occur in people of any age, and adult morbidity increases with age.
Peptic ulcer mainly refers to chronic ulcers that occur in the stomach and duodenum. It is a common and common disease. There are various factors in the formation of ulcers. The digestion of mucous membrane by acidic gastric juice is the basic factor of ulcer formation, hence the name. Any part of the contact with acidic gastric juice, such as the lower esophagus, anastomosis after gastrointestinal anastomosis, jejunum and Meckel's diverticulum with ectopic gastric mucosa, most ulcers occur in the duodenum and stomach, so it is also called stomach, ten Duodenal ulcer.
