Reflux cholangitis

　　Reflux cholangitis is caused by the dysfunction of the lower esophageal sphincter, and the reflux of gastric and (or) duodenal contents into the esophagus, leading to esophageal mucosal inflammation. The main cause of this disease is the weakening of the lower esophageal sphincter function, and the secondary esophageal peristalsis disorder is a factor that causes esophagitis to persist and worsen.

　　In addition to general symptoms, reflux cholangitis can also cause other diseases. This disease can also be complicated with gallstones, obstructive jaundice, and primary pancreatitis. Therefore, once detected, active treatment should be given, and preventive measures should also be taken in daily life.

　　Reflux cholangitis is relatively common in daily life, and its clinical manifestations are:

　　1. Recurrent cholangitis, mainly characterized by recurrent chills and high fever; it generally presents as remittent fever, with high temperatures reaching 39~40℃.

　　2. Persistent pain in the upper abdomen or upper right abdomen, rarely accompanied by colic.

　　3. It often accompanied by severe nausea and vomiting.

　　4. Jaundice rarely occurs. The condition worsens with an increase in the frequency of attacks.

　　5. Signs: tenderness or percussion pain in the upper right abdomen or liver area.

　　To prevent infection in patients with reflux cholangitis, effective antibiotics should be used promptly when inflammation occurs; the diet should be reasonably balanced, and excessive consumption of foods high in animal fats, such as lard and animal oil, should be avoided; when there are intestinal worms (mainly ascaris), prompt application of vermifugal drugs should be made, with sufficient dosage to prevent insufficient medication, as ascaris may become active and easily penetrate into the bile duct, causing obstruction and leading to cholecystitis.

　　In the diagnosis of reflux cholangitis, in addition to relying on clinical manifestations, auxiliary examinations are also needed. Patients should undergo gallbladder and bile duct ultrasound examination, CT examination, and upper gastrointestinal X-ray barium meal, etc.

　　Patients with reflux cholangitis should pay attention to a light diet, and it is best to consume easily digestible foods such as vegetable porridge and noodle soup. Patients can eat more fresh fruits and vegetables to ensure the intake of vitamins.

　　For patients with mild symptoms and infrequent attacks of reflux cholangitis, trial of anti-infection and biliary drainage therapy is recommended. The principle of surgical treatment is to repair or reconstruct the bile duct, and bile-enteric internal drainage can be supplemented with anti-reflux measures. Preoperative multiple and multi-directional imaging examinations of the biliary tract and gastrointestinal tract are performed, and intraoperative exploration is conducted to exclude diseases such as intrahepatic bile duct stones and strictures that may cause cholangitis, and to clarify the diagnosis of reflux cholangitis.

　　For patients who have undergone biliary-enteric anastomosis and developed reflux cholangitis, the occurrence of reflux cholangitis often harbors the risk of surgical failure. For the treatment of primary diseases, there are many surgical methods for biliary internal drainage, but clinical evidence shows that biliary jejunum Roux-en-Y is the best. However, there is still a concern about the occurrence of reflux cholangitis, which may be related to the defects of the anastomosis itself, the longer blind end of the output ileal loop, the insufficient length of the jejunal loop, and the insufficient anti-reflux effect. For the anti-reflux problem in biliary internal drainage, there are many anti-reflux surgical methods, such as Roux-en-Y anastomosis of the ileal loop, modified 'Y' ileal anastomosis angle, artificial ileal intubation or artificial papilla on the output ileum, etc. There is still some controversy about the effectiveness of these anti-reflux methods and which surgical method is better. In clinical practice, the Roux-en-Y biliary-enteric anastomosis is widely used, but some authors, based on the results of experimental research, show that there is no significant difference in the anti-reflux effect of the output ileal loop from 20cm to 75cm, and even if the length of the output ileal loop reaches 100cm, it cannot completely prevent the occurrence of reflux cholangitis. Currently, most authors choose to leave the jejunal loop for about 50cm to 60cm. To enhance the anti-reflux effect, after the jejunojejunal anastomosis, it is made into a 'Y' shape. The method is to suture two jejunal loops in parallel for 6cm to 8cm long to promote the chyme in the proximal ileum to be excreted smoothly into the distal ileum. However, there are also reports that if the anti-reflux effect is strong, it will weaken the force of bile stone excretion. Therefore, when adding an anti-reflux device for patients with intrahepatic bile duct calculi, the advantages and disadvantages should be weighed.

　　The specific surgical method selection is determined by the condition. The surgical exploration and imaging examination confirm that the original biliary-enteric anastomosis is narrow or completely occluded, and there is a stricture and calculus near the anastomosis. At this point, the original anastomosis has lost its significance. Remove all the calculi and correct the stricture of the intrahepatic bile duct, and establish a new unobstructed drainage. When encountering stricture of the common bile duct and intrahepatic bile duct during the reconstruction of internal drainage, it should be incised and shaped to prevent postoperative recurrence of stricture. For reflux caused by a short biliary-enteric 'Y' anastomosis, the treatment is relatively simple; extending the ileal loop solves the problem of reflux. For patients who have undergone biliary-enteric anastomosis and developed reflux cholangitis, the occurrence of reflux cholangitis often harbors the risk of surgical failure. For the treatment of primary diseases, there are many surgical methods for biliary internal drainage, but clinical evidence shows that biliary jejunum Roux-en-Y is the best. However, there is still a concern about the occurrence of reflux cholangitis, which may be related to the defects of the anastomosis itself, the longer blind end of the output ileal loop, the insufficient length of the jejunal loop, and the insufficient anti-reflux effect. For the anti-reflux problem in biliary internal drainage, there are many anti-reflux surgical methods, such as Roux-en-Y anastomosis of the ileal loop, modified 'Y' ileal anastomosis angle, artificial ileal intubation or artificial papilla on the output ileum, etc. There is still some controversy about the effectiveness of these anti-reflux methods and which surgical method is better. In clinical practice, the Roux-en-Y biliary-enteric anastomosis is widely used, but some authors, based on the results of experimental research, show that there is no significant difference in the anti-reflux effect of the output ileal loop from 20cm to 75cm, and even if the length of the output ileal loop reaches 100cm, it cannot completely prevent the occurrence of reflux cholangitis. Currently, most authors choose to leave the jejunal loop for about 50cm to 60cm. To enhance the anti-reflux effect, after the jejunojejunal anastomosis, it is made into a 'Y' shape. The method is to suture two jejunal loops in parallel for 6cm to 8cm long to promote the chyme in the proximal ileum to be excreted smoothly into the distal ileum. However, there are also reports that if the anti-reflux effect is strong, it will weaken the force of bile stone excretion. Therefore, when adding an anti-reflux device for patients with intrahepatic bile duct calculi, the advantages and disadvantages should be weighed.