Long-term effects in bilio-digestive shunts.

Duodenogastric reflux (DGR) and its effects were studied in patients with bile stones, operated by various bilio-digestive by-pass techniques, and followed up for 13-73 months. Ten patients underwent cholecystectomy and choledochoduodenostomy (CD), eight cholecystectomy and transduodenal sphincteroplasty (TDS) and ten cholecystectomy and endoscopic papillotomy (EP). The control group consisted of eight patients who had undergone minor surgery. DGR was studied by 99mTc-DISIDA scanning, and primary and secondary bile acids were assayed in reflux fluid. The effects were studied by gastroduodenoscopy and biopsies from the body of the stomach and antrum. Only patients operated by TDS (7/8) presented significant increases in DGR and bile acids (p < 0.008). Half the patients in this same group (4/8) had chronic atrophic gastritis and major clinical disorders. Some physiopathological mechanisms possibly involved in DGR and its effects are suggested.