Biliary reflux gastritis, also known as alkaline reflux gastritis, is a chronic inflammation of the gastric mucosa caused by dysfunction of the pyloric sphincter or surgery to reduce the function of the pylorus, which causes the flow of duodenal contents containing bile and pancreatic juice into the stomach, resulting in inflammation, erosion and bleeding of the gastric mucosa, weakening the barrier function of the gastric mucosa and causing increased diffusion.
I. Etiology
The etiology of bile reflux gastritis is mainly after major gastrectomy, gastrojejunostomy, as well as pyloric malfunction and chronic biliary tract diseases.
II. Clinical manifestations
1.Abdominal distension
This is one of the main symptoms, manifesting as abdominal fullness and discomfort, continuous burning sensation in the upper and middle abdomen, and also as retrosternal pain, which can be aggravated after meals.
2, heartburn
There is a burning sensation in the stomach and even in the esophagus in some patients, often accompanied by belching, acid reflux, nausea, vomiting, intestinal tinnitus, poor bowel movement, loss of appetite and wasting.
3. Gastric bleeding
In severe cases of bile reflux gastritis, there is also gastric bleeding, with some patients having black stools or vomiting blood.
4. Vomiting
Due to impaired gastric emptying, vomiting usually occurs in the evening or in the middle of the night, and some patients have blood in their vomit.
Three, examination
1.Gastroscopic examination
Reflux manifestations can be observed endoscopically: i.e., a large amount of light yellow to yellow-green bile in the gastric cavity, or more mucus containing bile attached to the gastric wall, or duodenal fluid containing bile is seen to flow back into the stomach from the pyloric orifice in the form of foam or water flow, and the pyloric orifice is relaxed or in an open and fixed state; gastritis manifestations: diffuse red changes in the gastric mucosa, edema of the mucosal folds, contact bleeding, or accompanied by erosion or ulceration.
2.Gastric aspirate determination
By inserting a gastric tube from the patient’s nasal cavity to reach the gastric cavity, followed by aspiration of fasting and postprandial gastric juice, the bile acid content is measured, and if the fasting basal gastric acid secretion is <3.5mmol/h and bile acid exceeds 30ug/ml, the diagnosis of bile reflux gastritis is confirmed.
3.Isotope measurement
By intravenous injection of 99mTc-butyliminodiacetic acid, the liver, gallbladder and gastric region were observed to determine the index of gastrointestinal reflux. The degree of gastrointestinal reflux can be understood by testing the isotope content in the stomach.
IV. Diagnosis
The diagnosis and differentiation of bile reflux gastritis mainly rely on gastroscopy and and gastric aspirate determination, and isotope determination can understand the degree of reflux.
V. Complications
The disease can be complicated by esophageal stricture, bleeding, and ulcers. Chronic pharyngitis, chronic vocal fold inflammation and bronchitis, known as Delahunty’s syndrome, can be caused by the refluxed gastric juice attacking the pharynx, vocal folds and trachea. Gastric reflux and inhalation into the respiratory tract can lead to aspiration pneumonia.
VI. Treatment
1.Drug treatment
Gastric power drugs can increase gastrointestinal peristalsis, inhibit bile reflux into the stomach, commonly used: domperidone, mosapride. Gastric mucosa protective agents: aluminum thioglycollate, can combine with the mucin of the gastric mucosa to form a protective film to protect the gastric mucosa from bile damage; gastrin, can form a membrane in the stomach to cover the gastric mucosa to reduce the reflux of bile and gastric acid stimulation of the gastric mucosa; montmorillonite, a gastric mucosa protective agent, has the effect of strengthening the mucosal barrier of the digestive tract, conducive to the regeneration of the gastric mucosa; gastrodin, can promote the secretion of mucus from the gastric mucosa, thereby protecting the gastric mucosa; aluminum phosphate. thus protecting the gastric mucosa; aluminum phosphate gel, which protects the gastric mucosa and promotes the healing of inflammation.
2.Surgical treatment
It is mainly applied to those whose symptoms are not effective in medical treatment, and the commonly used surgical procedures are Roux-en-Y surgery or biliary shunt.
3.Dietary adjustment
The diet should be light, no greasy food, so as not to stimulate the increase of bile secretion and aggravate the reflux and condition. You should chew and swallow slowly and avoid overeating. Avoid drinking strong tea, alcohol, strong coffee and eating spicy, cold, hot and rough food.
4. Remove certain factors that aggravate the condition
Avoid smoking and alcohol, avoid mental tension, keep your mood relaxed, and do not take or be careful to take drugs that stimulate the gastric mucosa.