Skip to main content

Duodenogastric bile reflux and gastrointestinal motility in pathogenesis of functional dyspepsia

Role of cholecystectomy

Digestive Diseases and Sciences volume 40, pages 1703–1709 (1995)Cite this article

Abstract

To establish the pathogenic role of duodenogastric reflux in dyspeptic symptoms we have compared the clinical features, gastrointestinal motility, and rates of duodenogastric bile reflux in 12 cholecistectomized dyspeptic patients, 12 dyspeptic patients with intact gallbladder, and 12 healthy controls. Specific symptoms were scored for severity and frequency. Gastrointestinal manometry was performed during 3 hr of fasting and 2 hr postprandially. Simultaneously, samples of duodenal and gastric contents were obtained sequentially for quantification of bile acids. Results show that symptom global severity (9.6±0.4 vs 8.8±0.7) and frequency (9.9±0.8 vs 9.0±0.5) were similar in both dyspeptic groups; only abdominal pain was milder in cholecystectomized patients (1.9±0.1 vs 2.6±0.2;P<0.05). Fasting gastric bile acid concentrations were higher in cholecystectomized patients (P<0.05) and antral postcibal motility lower (P<0.05) than in the other groups. No relation among gastric hypomotility, duodenogastric bile reflux, and symptom scores was detected. We concluded that patients with functional dyspepsia and a prior cholecystectomy have clinical features similar to those with gallbladders, but some physiological features are dissimilar: antral motility is decreased and duodenogastric bile reflux is increased. Thus, a uniform clinical expression of various pathophysiological disturbances constitutes the basis of functional dyspepsia.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

References

  1. Barbara L, Camilleri M, Corinaldesi R, et al.: Definition and investigation of dyspepsia. Consensus of an international ad hoc working party. Dig Dis Sci 34:1272–1276, 1989

    Google Scholar 

  2. Bernersen B Johnson R, Straume B, Burhol PG, Jenssen TG, Stakkevold PA: Towards a true prevalence of peptic ulcer: The Sorreisa gastrointestinal disorders study. Gut 31:989–992, 1990

    Google Scholar 

  3. Mearin F, Malagelada J-R: Upper gut motility and perception in functional dyspepsia. Eur J Gastroenterol Hepatol 4:615–621, 1992

    Google Scholar 

  4. Mearin F, Cucala M, Azpiroz F, Malagelada J-R: The origin of symptoms on the brain-gut axis in functional dyspepsia. Gastroenterology 101:999–1006, 1991

    Google Scholar 

  5. Ros E, Zambon D: Postcholecystectomy symptoms. A prospective study of gall stone patients before and two years after surgery. Gut 28:1500–1504, 1987

    Google Scholar 

  6. Müller-Lissner SA, Schindlbeck NE, Heinrich C: Bile salt reflux after cholecystectomy. Scand J Gastroenterol (Suppl) 139:20–24, 1987

    Google Scholar 

  7. Hubens A, Van de Kelft E, Roland J: The influence of cholecystectomy on the duodenogastric reflux of bile. Hepatogastroenterology 36:384–386, 1989

    Google Scholar 

  8. Malagelada J-R, Stanghellini V: Manometric evaluation of functional upper gut symptoms. Gastroenterology 88:1223–1231, 1985

    Google Scholar 

  9. Arndorfer RC, Stef JJ, Dodds WJ, Lineham JH, Hogan WJ: Improved infusion system for intraluminal esophageal manometry. Gastroenterology 73:23–27, 1977

    Google Scholar 

  10. Talalay P, Dobson MD: Purification and properties of β-hydroxy-steroid dehydrogenase. J Biol Chem 205:823–837, 1953

    Google Scholar 

  11. Bost R, Hostein J, Valenti M, Bonaz B, Payen N, Faure H, Fournet J: Is there an abnormal fasting duodenogastric reflux in nonulcer dyspepsia? Dig Dis Sci 35:193–199, 1990

    Google Scholar 

  12. George AA, Tsuchiyose M, Dooley CP: Sensitivity of the gastric mucosa to acid and duodenal contents in patients with nonulcer dyspepsia. Gastroenterology 101:3–6, 1991

    Google Scholar 

  13. Brough WA, Taylor TV, Torrance HB: The effect of cholecystectomy on duodenogastric reflux in dogs and humans. Scand J Gastroenterol (Suppl) 19:242–244, 1984

    Google Scholar 

  14. Larusso D, Pezzolla F, Cavallini A, et al: A prospective study on duodenogastric reflux and on histological changes in gastric mucosa after cholecystectomy. Gastroenterol Clin Biol 16:328–333, 1992

    Google Scholar 

  15. Watson RGP, Love AHG: Intragastric bile acid concentrations are unrelated to symptoms of flatulent dyspepsia in patients with and without gallbladder disease and postcholecystectomy. Gut 28:131–136, 1987

    Google Scholar 

  16. Talley NJ, Shuter B, McCrudden G, Jones M, Hoschi R, Piper DW: Lack of association between gastric emptying of solids and symptoms in nonulcer dyspepsia. J Clin Gastroenterol 11:625–630, 1989

    Google Scholar 

  17. Corinaldesi R, Stanghellini V, Raiti C, Rea E, Salgemini R, Barbara L: Effect of chronic administration of cisapride on gastric emptying of a solid meal and on dyspeptic symptoms in patients with idiopathic gastroparesis. Gut 28:300–305, 1990

    Google Scholar 

  18. Davis RH, Clenh MH, Mathias JR: Effects of domperidone in patients with chronic unexplained upper gastrointestinal symptoms: A double-blind, placebo-controlled study. Dig Dis Sci 33:1505–1511, 1988

    Google Scholar 

  19. Labó G, Bortolotti M, Vezzadini P, Bonora G: Interdigestive gastroduodenal motility and serum motilin levels in patients with idiopathic delay in gastric emptying. Gastroenterology 90:20–26, 1986

    Google Scholar 

  20. Testoni PA, Fanti L, Passaretti S, Masci E, Guslandi M, Tittobello A: Interdigestive motility pattern in subjects with duodenogastric bile reflux. Scand J Gastroenterol 22:757–762, 1987

    Google Scholar 

Download references

Author information

Affiliations

  1. Digestive System Research Unit, Hospital General Universitari Vall d'Hebron, 08035, Barcelona, Spain

    Fermín Mearin MD, Xavier De Ribot MD, Agustín Balboa MD, María Antolín MD, Modesto J. Varas MD & Juan-R. Malagelada MD

  2. Hospital de la Cruz Roja, Hospitalet de Llobregat, Spain

    Fermín Mearin MD, Xavier De Ribot MD, Agustín Balboa MD, María Antolín MD, Modesto J. Varas MD & Juan-R. Malagelada MD

Authors
  1. Fermín Mearin MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Xavier De Ribot MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Agustín Balboa MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. María Antolín MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Modesto J. Varas MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Juan-R. Malagelada MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Mearin, F., De Ribot, X., Balboa, A. et al. Duodenogastric bile reflux and gastrointestinal motility in pathogenesis of functional dyspepsia. Digest Dis Sci 40, 1703–1709 (1995). https://doi.org/10.1007/BF02212691

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF02212691

Key Words

  • functional dyspepsia
  • postcholecystectomy dyspepsia
  • postcholecystectomy syndrome
  • duodenogastric reflux
  • gastrointestinal manometry
  • gastric motility