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World Journal of Surgery

, Volume 5, Issue 2, pp 189–196 | Cite as

Role of bile acid reflux in acute hemorrhagic gastritis

  • Wallace P. RitchieJr.
Article

Abstract

A model was developed to assess the influence of bile acids on the ability of proximal canine gastric mucosa to maintain an intraluminal pH gradient and to resist acute morphologic injury. It was found that the combination of topical acid, topical bile acid, and mucosal ischemia is acutely and severely ulcerogenic. Lesion severity is a function of the absolute amount of H+; diffusing into the mucosa which is, itself, a function of the intraluminal concentrations of both bile and H+. Morphologic injury is associated with the development of a marked gastric venous acidosis. Bile acid species differ in their capacity to induce lesions. Topical application of bile acids to nonischemic mucosa is not acutely ulcerogenic because a compensatory increase in mucosal blood flow occurs which is proportional to the degree of H+ loss induced. In the present model, steroids are “cytoprotective” by virtue of this mechanism, while histamine H1 and H2 receptor antagonists, either along or in combination, are not. The clinical applicability of these findings is discussed.

Keywords

Bile Acid Gastritis Acid Reflux Mucosal Blood Flow Mucosal Ischemia 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Résumé

Un modèle expérimental a été mis au point pour évaluer l'influence des acides biliaires sur la muqueuse gastrique fundique du chien. Nous voulions étudier la capacité de cette muqueuse à maintenir un gradient de pH vers la lumière digestive et sa résistance à 1'aggression biliaire. Lorsque la muqueuse est baignée par une solution acide et des acides biliaires et qu'elle est, de plus, en ischémie, des ulcerations aiguës et graves apparaissent. La gravité des lésions est fonction de la quantité absolue d'H+ diffusant dans la muqueuse qui est, ellemême, proportionnelle aux concentrations intraluminales d'acides biliaires et d'H+. Le développement des lésions est concomittant d'une acidose veineuse importante dans la muqueuse gastrique. La capacité de produire des lésions est variable pour les divers acides biliaires. L'application locale d'acides biliaires sur une muqueuse non ischémiée ne provoque pas l'apparition d'ulcerations aiguës, par un accroissement compensatoire du flux sanguin muqueux qui est proportionnel à l'importance de la perte d'H+. Par le même mécanisme, les stéroides sont cytoprotecteurs dans le modèle étudié, alors que les antagonistes des récepteurs H1 et H2, seuls ou combinés, ne le sont pas. L'application clinique de ces données est discutée.

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Copyright information

© Société Internationale de Chirurgie 1981

Authors and Affiliations

  • Wallace P. RitchieJr.
    • 1
  1. 1.Department of SurgeryUniversity of Virginia School of MedicineCharlottesvilleUSA

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