Postoperative alkaline reflux gastritis: a prospective clinical study of etiology and treatment.

A significant linear relationship exists between recumbent and postprandial intragastric bile acid concentration, net bile acid reflux/hour, and the severity of nonstomal histologic gastritis in the residual gastric pouch following gastrectomy. Using objective criteria, it is possible to identify symptomatic patients with greater than normal bile acid reflux and histologic gastritis. In these patients, Roux-Y reconstruction eliminates bile acid reflux, slows gastric emptying, improves histologic gastritis, and appears to ameliorate some (but not all) of the symptoms and signs ascribed to 'alkaline reflux gastritis'. However, because of the apparent clinical homogeneity between refluxing and non-refluxing symptomatic patients, these data, although supportive, do not clearly prove the existence of the syndrome.