What Are the Pros and Cons of Acid Reflux Surgery?

Post-surgery reflux gastritis is a gastrointestinal pain in patients with upper abdominal burning pain, nausea, and vomiting. Patients often suffer from aggravated epigastric pain after meals, which cannot be alleviated after vomiting; reduced food intake leads to weight loss and anemia.

Basic Information

Visiting department

Basic surgery

Multiple groups

Patients after stomach surgery

Common locations

stomach

Common causes

Pyloric defense dysfunction of bile reflux

Common symptoms

Persistent or irregular burning pain in the middle and upper abdomen, slightly worse after eating, bile vomiting in the morning, etc.

Causes of reflux gastritis after surgery

There is a layer of mucus on the surface of normal gastric mucosa, which has a shielding effect on hydrogen ions, so that gastric acid stays in the gastric cavity only. When the pyloric defense mechanism of bile reflux is abnormal, bile flows back into the stomach and even into the esophagus. The bile acid flowing back into the stomach destroys the barrier function of the mucosal layer on the surface of the gastric mucosa. The mucus layer on the surface of the cells on the gastric mucosa no longer has a functional barrier function to prevent the reverse diffusion of hydrogen ions and the inflow of sodium ions. As a result, bile acids cause release of histamine in gastric mucosa, increased permeability of gastric mucosa, increased reverse diffusion of hydrogen ions and sodium ions in gastric mucosa, mucosal edema, mucosal acidosis, mucosal trophic ischemia, and postoperative reflux Gastritis.

Clinical manifestations of reflux gastritis after surgery

Symptoms can appear within a few days to years after the operation, with persistent or irregular burning pain in the mid-upper abdomen, which worsens slightly after eating, and it is ineffective to take antacids. 15% to 25% exuded bile or had bile vomiting, no obvious relief of symptoms after vomiting, vomiting often occurred in the morning when awake. X-ray barium radiography does not confirm the diagnosis. Hemorrhage due to gastric mucosal erosion can cause hypopigmented anemia after surgery.

Examination of reflux gastritis after surgery

Gastric-esophageal scintigraphy

Reflux can be measured for radiolabeled meals. Sensitivity and specificity are about 90%.

Gastroscopy

Reflux gastritis gastroscopy shows redness of the gastric body or residual gastric mucosa, congestion and edema, fragile tissues, easy bleeding on contact, superficial ulcers, and submucosal vascular crests seen under gastroscopy.

3. Specimen microscopy

Parietal cells are rare, superficial ulceration, bleeding, mucosal atrophy, chronic inflammation with lymphocyte infiltration.

Diagnosis of reflux gastritis after surgery

Common clinical symptoms are epigastric pain and bile vomiting. Gastroscopy is the most important step in the diagnosis of reflux gastritis. Stomach-esophageal scintigraphy helps diagnosis.

Differential diagnosis of reflux gastritis after surgery

After bile surgery, reflux gastritis should be distinguished from the input iliac syndrome, which is caused by intermittent obstruction near the anastomosis of the input iliac. The two have similarities, but different treatments. Input syndrome manifests as paroxysmal epigastric pain and bloating after eating, often with bile vomiting, but symptoms are relieved after vomiting. Because food has entered the output before vomiting, there is no food in the vomit. X-ray barium imaging can confirm the diagnosis.

Complications of reflux gastritis after surgery

1. Some patients often return to the throat due to gastric contents, which can cause throat symptoms: chronic laryngitis, dysphonia, sore throat, and periodontitis.

2. Reflux can cause many lung diseases: bronchitis, chronic cough, aspiration pneumonia, etc.

Treatment of reflux gastritis after surgery

Drug treatment

The effect of drug treatment is not obvious, especially those with obvious bile vomiting. However, drug treatment may relieve some temporary symptoms, eliminate mild clinical manifestations, and allow doctors to continuously observe and judge patients within a period of time, which is conducive to the determination of surgical plans.

(1) Bile salt adsorbent The traditional effective drug is aluminum hydroxide, which can non-specifically adsorb bile salts and lysolecithin and other potentially toxic substances. Cholestyramine is an anion-exchange resin, which can be combined with bile acid in the stomach and discharged from the body to reduce the damage of bile acid to the gastric mucosa, thereby reducing symptoms. Similar drugs, such as lipid-lowering resins No. and , are produced in China. They are mainly used for the treatment of hypercholesterolemia. The principle of the two is the same as that of cholestyramine. It can also be used for the treatment of this disease. Secondary constipation makes it difficult for patients to tolerate, which limits their application.

(2) Drugs that promote gastric emptying Commonly used drugs are metoclopramide and madrin, which can increase the frequency and intensity of residual gastric contractions, adjust the movement of the gastric antrum and duodenal bulb, and therefore promote gastric emptying Effect, can reduce bile counterflow, reduce the time of duodenal content and gastric mucosa contact.

(3) Quit smoking Smoking can increase bile reflux, so patients should quit. Intravenous nutrition can reduce the secretion of bile and pancreatic juice. After 2 to 4 weeks of clinical treatment, gastroscopy and living tissues are reviewed, and gastritis has improved significantly. It is particularly suitable for those with weak constitution and malnutrition, and can be used as a preoperative preparation.

2. Surgical treatment

Those who fail to respond to medication and whose symptoms persist for more than one year may consider surgery. The main purpose of the operation is to prevent the duodenal contents from coming close to or coming into contact with the stomach, which is almost certainly achieved. Which surgical correction method is used depends on the original operation and the experience of the surgeon.

(1) Roux-en-Y gastrojejunostomy This is currently considered to be the most effective surgical method. In order to ensure that the contents of the duodenum flow into the jejunum but cannot flow back to the stomach, the new input jejunum entrance should be 50cm below the gastrointestinal anastomosis Office. Patients who have previously undergone vagalectomy and pyloroplasty who have had reflux gastritis after bile surgery. Reoperations include hemi-gastrectomy and anterior colon Roux-en-Y gastric jejunostomy. After surgery, bile flows back through Roux-en-Y, and the secretory cells in the residual stomach will regenerate and continue to secrete gastric acid. At this time, gastric acid re-secrets and loses the neutralization of alkaline fluid, which can cause gastrointestinal anastomosis. Marginal ulcers. Therefore, even if the gastric acid deficiency or absence of acid is checked before surgery, it is still necessary to add vagus nerve cut.

(2) Henley's ridge is a section of jejunum inserted between the stomach and duodenum (Henley's ridge). It is suitable for reflux gastritis after bile surgery after Bi-type gastrojejunostomy. The input jejunum crest is separated near the gastric side and closed at the gastric end. The output crest was separated 20 cm away from the stomach, and the 20 cm output jejunum segment coincided with the duodenal stump, thereby reconstructing and reconstructing the connection between the stomach and the duodenum. Anastomosis of the proximal input crest from the duodenum with the distal end of the output jejunum crest restored the small intestine connection below the flexor ligament.

Prognosis of reflux gastritis after surgery

The clinical effect of drug or surgery is satisfactory.

Prevention of reflux gastritis after surgery

1. Diet The diet should be light, do not eat greasy food, so as not to stimulate the increase in bile secretion, increase reflux and illness. Should chew slowly and avoid overeating. Avoid drinking strong tea, spirits, espresso, and eating spicy, cold, hot, and rough foods.

2. Eliminate certain factors that aggravate the condition including quitting smoking, avoiding emotional stress, and not taking drugs that irritate the gastric mucosa, such as aspirin, indomethacin, Qutong tablets, and Baotai Song.