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Bile Reflux and Gastroparesis

  • Robert E. RosesEmail author
  • Douglas L. Fraker
Chapter

Abstract

Postoperative gastroparesis and bile reflux are among the more problematic complications of upper abdominal surgery. Gastroparesis has received much attention in the literature as a complication of pancreaticoduodenectomy, but is, perhaps, an even more troubling complication after other foregut operations (e.g., gastric resection). Characterized by nausea and vomiting in the presence of distal bowel function, the diagnosis of gastroparesis requires exclusion of a mechanical obstruction. Persistent gastroparesis can result in malnutrition and have a profound impact on the quality of life. Bile reflux is most often a sequelae of gastroduodenal resection or ablation of the pylorus and its mechanism is intuitive. Although bile transits the stomach and may reflux into the esophagus after typical gastric and duodenal resections (except for those in which a roux-en-y reconstruction is utilized) and is often accompanied by mild mucosal irritation, the clinical syndrome of bile reflux develops in a minority of patients and is characterized by symptoms of pain and vomiting refractory to pharmacologic or behavioral intervention. Characterization of specific factors contributing to both of these complications and effective therapies are lacking. Remedial surgery has a role in the management of both clinical entities but careful patient selection is critical in achieving good outcomes.

Keywords

Bile reflux Gastroparesis Pancreaticoduodenectomy Gastric resection Nausea Vomiting Gastroduodenal resection Ablation of the pylorus Mucosal irritation  

References

  1. 1.
    Tani M, et al. Improvement of delayed gastric emptying in pylorus-preserving pancreaticoduodenectomy: results of a prospective, randomized, controlled trial. Ann Surg. 2006;243(3):316–20.CrossRefPubMedCentralPubMedGoogle Scholar
  2. 2.
    Qu H, et al. Clinical risk factors of delayed gastric emptying in patients after pancreaticoduodenectomy: a systematic review and meta-analysis. Eur J Surg Oncol. 2013;39(3):213–23.CrossRefPubMedGoogle Scholar
  3. 3.
    Tran KT, et al. Pylorus preserving pancreaticoduodenectomy versus standard Whipple procedure: a prospective, randomized, multicenter analysis of 170 patients with pancreatic and periampullary tumors. Ann Surg. 2004;240(5):738–45.CrossRefPubMedCentralPubMedGoogle Scholar
  4. 4.
    Fraser AG, Brunt PW, Matheson NA. A comparison of highly selective vagotomy with truncal vagotomy and pyloroplasty–one surgeon’s results after 5 years. Br J Surg. 1983;70(8):485–8.CrossRefPubMedGoogle Scholar
  5. 5.
    Stoddard CJ, Vassilakis JS, Duthie HL. Highly selective vagotomy or truncal vagotomy and pyloroplasty for chronic duodenal ulceration: a randomized, prospective clinical study. Br J Surg. 1978;65(11):793–6.CrossRefPubMedGoogle Scholar
  6. 6.
    Traverso LW, Hashimoto Y. Delayed gastric emptying: the state of the highest level of evidence. J Hepatobiliary Pancreat Surg. 2008;15(3):262–9.CrossRefPubMedGoogle Scholar
  7. 7.
    Yeo CJ, et al. Erythromycin accelerates gastric emptying after pancreaticoduodenectomy. A prospective, randomized, placebo-controlled trial. Ann Surg. 1993;218(3):229–37. Discussion 237–8.CrossRefPubMedCentralPubMedGoogle Scholar
  8. 8.
    Fich A, et al. Stasis syndromes following gastric surgery: clinical and motility features of 60 symptomatic patients. J Clin Gastroenterol. 1990;12(5):505–12.CrossRefPubMedGoogle Scholar
  9. 9.
    Miedema BW, et al. Human gastric and jejunal transit and motility after Roux gastrojejunostomy. Gastroenterology. 1992;103(4):1133–43.PubMedGoogle Scholar
  10. 10.
    Troncon LE, et al. Abnormal intragastric distribution of food during gastric emptying in functional dyspepsia patients. Gut. 1994;35(3):327–32.CrossRefPubMedCentralPubMedGoogle Scholar
  11. 11.
    Janssens J, et al. Improvement of gastric emptying in diabetic gastroparesis by erythromycin. Preliminary studies. N Engl J Med. 1990;322(15):1028–31.CrossRefPubMedGoogle Scholar
  12. 12.
    Speicher JE, et al. Results of completion gastrectomies in 44 patients with postsurgical gastric atony. J Gastrointest Surg. 2009;13(5):874–80.CrossRefPubMedGoogle Scholar
  13. 13.
    Forstner-Barthell AW, et al. Near-total completion gastrectomy for severe postvagotomy gastric stasis: analysis of early and long-term results in 62 patients. J Gastrointest Surg. 1999;3(1):15–21. Discussion 21–3.CrossRefPubMedGoogle Scholar
  14. 14.
    Familoni BO, et al. Efficacy of electrical stimulation at frequencies higher than basal rate in canine stomach. Dig Dis Sci. 1997;42(5):892–7.CrossRefPubMedGoogle Scholar
  15. 15.
    McCallum R, et al. Clinical response to gastric electrical stimulation in patients with postsurgical gastroparesis. Clin Gastroenterol Hepatol. 2005;3(1):49–54.CrossRefPubMedGoogle Scholar
  16. 16.
    Oubre B, et al. Pilot study on gastric electrical stimulation on surgery-associated gastroparesis: long-term outcome. South Med J. 2005;98(7):693–7.CrossRefPubMedGoogle Scholar
  17. 17.
    Abrahamsson H. Treatment options for patients with severe gastroparesis. Gut. 2007;56(6):877–83.CrossRefPubMedCentralPubMedGoogle Scholar
  18. 18.
    Dixon MF, et al. Reflux gastritis: distinct histopathological entity? J Clin Pathol. 1986;39(5):524–30.CrossRefPubMedCentralPubMedGoogle Scholar
  19. 19.
    Meshkinpour H, et al. Effect of cholestyramine on the symptoms of reflux gastritis. A randomized, double blind, crossover study. Gastroenterology. 1977;73(3):441–3.PubMedGoogle Scholar
  20. 20.
    Zobolas B, et al. Alkaline reflux gastritis: early and late results of surgery. World J Surg. 2006;30(6):1043–9.CrossRefPubMedGoogle Scholar
  21. 21.
    Sousa JE, et al. Comparison between Henley jejunal interposition and Roux-en-Y anastomosis as concerns enterogastric biliary reflux levels. Ann Surg. 1988;208(5):597–600.CrossRefPubMedCentralPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  1. 1.Division of Endocrine and Oncologic Surgery, Department of Surgery, Perelman Center for Advanced Medicine, Hospital of the University of PennsylvaniaUniversity of Pennsylvania School of MedicinePhiladelphiaUSA
  2. 2.Department of SurgeryUniversity of PennsylvaniaPhiladelphiaUSA

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