Alkaline Reflux Gastritis and Esophagitis

Alkaline reflux (bile) gastritis and esophagitis result from mucosal injury by duodenal contents. Bile gastritis occurs after gastric surgery, cholecystec­ tomy, ampullary sphincteroplasty , and, rarely, in nonoperated patients. Diagnostic features include chronic, continuous epigastric pain, ex­ acerbated by eating, bilious vomiting, weight loss, iron deficiency anemia, achlorhydria, gastritis, and intragastric bile. The pathophysiology prob­ ably relates to excess enterogastric reflux and bile-induced mucosal damage. There is no perfect diagnostic test, but chemical and scintigraphic documentation of enterogastric reflux, as well as provocative testing with alkali solutions, are promising new techniques. Medical therapy with antacids, H2 antagonists, bile salt absorbants, and metoclopramide has been without significant benefit. Prostaglandins and sucralf ate are now being evaluated. Surgical therapy that diverts duodenal contents away from the stomach is usually of benefit in appropriately selected patients. Alkaline reflux esophagitis shares many features with alkaline gastritis.