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Query: UMLS:C0042963 (vomiting)
 31,883 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Bile reflux gastritis is a disabling postgastrectomy condition characterized by abdominal pain, bilious vomiting, and weight loss. The syndrome appears to be caused by free enterogastric reflux of bile and other proximal small bowel constituents. Endoscopic confirmation of bile reflux and documentation of gastritis support the diagnosis but are not specific for it. Results of medical therapy with chelating agents or drugs that promote gastric motility have been disappointing. Diet and antacids frequently aggravate symptoms. The only effective treatment is surgical diversion of bile away from the gastric mucosa. During a recent seven-year period, 15 patients had diversionary operation for bile reflux gastritis diagnosed by history and endoscopic findings. Before operation, medical management had failed to yield improvement in any case. After operation, all patients showed improvement, and pain was relieved in 85%. Based on our experience, we conclude that current medical therapy may alter but not cure symptoms of bile reflux gastritis; Roux-en-Y diversion is the treatment of choice in patients with persistent symptoms; and delayed gastric emptying is a common complication after the Roux-en-Y procedure, but in our series, the incidence was reduced by using the Tanner 19 modification. New cytoprotective agents that may offer an alternative to operation are currently being studied.
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PMID:Bile reflux gastritis. 381 Feb 8

Alkaline reflux gastritis following gastric surgery is an ill-defined syndrome characterised by epigastric pain, bile vomiting and weight loss. Endoscopy and gastric histology do not confirm the diagnosis. It appears that duodenal contents refluxing into the stomach are the cause of this entity. In an effort to quantify this attempts have been made to quantitate the reflux. Techniques include measuring bile acids in fasting gastric aspirates and, more recently, Tc HIDA scanning. Tolin et al showed a good correlation between the enterogastric reflux index and patients with symptoms of alkaline reflux gastritis. Recent work has suggested that HIDA reflux is difficult to quantitate. Recently Meshkinpour et al induced the symptoms of alkaline reflux gastritis by infusing endogenous duodenal juice onto the gastric mucosa. This paper confirms those findings and uses the technique to improve patient selection for Roux-en-Y diversion.
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PMID:The use of an instillation test to define alkaline reflux gastritis. 658 28

Bile reflux gastritis has been recognized since the first successful gastric operations and has persisted for more than a century. Diagnosis has been difficult and non-operative therapy largely ineffective. Early attempts at surgical correction resulted in stomal ulceration and it was not until the advent of flexible endoscopy and other techniques that diagnosis became more secure. Operative attempts at correction have included the Roux-en-Y procedure, the Braun enteroenterostomy, and Henley jejunal interposition. None of the procedures has been uniformly successful, and the Roux-en-Y has resulted in a disabling stasis syndrome in most patients. The diagnosis of bile reflux without previous gastric surgery has been even more elusive and seems to be associated with previous cholecystectomy. Thirty-one patients diagnosed with primary bile reflux, having typical symptoms of epigastric pain, nausea, and bilious vomiting have been treated by diverting bile flow through a Roux-en-Y choledochojejunostomy without accompanying gastric resection or vagotomy. There were no operative deaths and no long-term problems, such as anastomotic stricture. Two patients had self-limited bile leaks. Twenty-seven of the 31 patients (87%) have achieved complete relief of symptoms and have no gastrointestinal complaints. Serial gastric emptying has demonstrated no alteration in 9 of 12 patients who were normal before operation, and improvement in 12 of the 19 (63%) patients with abnormal preoperative studies.
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PMID:Primary bile reflux gastritis: diagnosis and surgical treatment. 1294 31

There are few published surgical reports on peptic ulcer disease (PUD) in Ethiopia. Of 405 complicated peptic ulcer patients operated on in Tikur Anbessa Hospital, Addis Ababa, from 1997 to 2001, the records of 351 patients were retrieved and retrospectively analyzed to assess the pattern of PUD complication and the outcome of surgical treatment. During the study period, complicated PUD patients comprised 3.8% of the total major surgical procedures. The male to female ratio was 5.6: 1.0. The mean age was 36.5 +/- 12.7 years. Of 351 patients, 337 (96%) had abdominal pain, in most epigastric, and 330 (94%) had vomiting as presenting complaints. Dehydration was observed in 44 (12.5%). Gastric outlet obstruction (GOO) was the commonest complication followed by perforation that necessitated surgical intervention. The commonest operative procedure was truncal vagotomy and drainage. Nearly 5.0% died in hospital, most from complicated perforated peptic ulcer. Follow-up was possible in 262 patients for a mean of 16.2 +/- 15.0 months. Dumping and diarrhea were observed in 2.7% and 0.4% of the patients, respectively. Bile reflux gastritis was encountered in 1.5%. Truncal vagotomy and drainage remained to be easily learnable procedures with acceptable morbidity and mortality rates.
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PMID:Complicated peptic ulcer disease in Tikur Anbessa Hospital, Addis Ababa. 1689 25