|UDK: 616.361-089.87-06:616.33-002||ISSN 0350-2899, 29(2004) 4 p.242-246|
Reflux Gastritis after Cholecystectomy - a Precancerous Condition?
Zoran Joksimović (1), Dušan Bastać (2), Nebojša Paunković (3)
Bile induced gastritis due to duodenogastric reflux after cholecystectomy has got a special clinical importance and involved many mechanisms in pathogenesis. This entity has not been studied sufficiently yet, and firm data about an increased incidence of bile gastritis after surgical removal of the gallbladder are lacking. 27 patients with cholecystectomy due to gallstones, 15 female and 12 male, with average age of 55 were examined. Symptoms, like upper abdominal pain, nausea and vomiting indicated the upper endoscopying. pH value of gastric content was measured by indicators band. Gastric mucosal specimens for patohistological examination and urease Hellicobacter pylori test, were obtained by endoscopic forceps biopsy. Bile reflux and presence of bile in stomach in all 27 patients were established by endoscopic examination. In all cases was observed localized and diffuse hyperaemia. pH value varies from 2.0 to 5.5 with the average value of 3.9. In all patients patohistological finding have the image of chronic reactive gastritis. In 10 (37%) patients metaplastic changes were observed. In 17 (63%) patients presence of Helicobacter pylori in gastric mucosa has been proven. Helicobacter pylori infection was registered in 90% patients with metaplastic changes. Average gastric pH value in patients with metaplasia was 4.5. Helicobacter pylori infection was registered in subjects with increased pH value (when it was 3.5 and more, average 4.3). A positive correlation between degree of difficulty of endoscopic and patohistological alteration and increase of gastric secretions was obtained. Positive correlation between gastric mucosa alteration and presence of Helicobacter pylori was found. Also, there is a link between presence of Helicobacter pylori and pH values of gastric contents. This finding suggests a cancerogenous role of duodenogastric reflux, especially in combination with Helicobacter pylori infection of gastric mycoses.
Key words: Bile reflux, gastritis, cholecystectomy, gastric pH value, Helicobacter pylori, intestinal metaplasia, gastric carcinoma, prevention.
Napomena: kompletan tekst rada na srpskom jeziku
Note: full text in Serbian
Privatna internistička ordinacija ”Joksimović”
Paper received: 9.11.2004
Paper accepted: 7.12.2004
Published online: 20.01.2005
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