Postoperative reflux gastritis

　　1. Etiology

　　The normal gastric mucosal surface has a layer of mucus, which has a shielding effect on hydrogen ions, causing gastric acid to remain only in the gastric cavity. When the pyloric defense mechanism against bile reflux is abnormal, bile refluxes into the stomach, and even into the esophagus. The bile acids refluxing into the stomach destroy the barrier function of the mucus layer on the surface of the gastric mucosa, and the mucus layer on the surface of the cells of the gastric mucosa no longer has the functional barrier effect of shielding the reverse diffusion of hydrogen ions and the influx of sodium ions. The result is that bile acids cause the release of histamine in the gastric mucosa, increase the permeability of the gastric mucosa, increase the reverse diffusion of hydrogen ions and sodium ions in the gastric mucosa, edema of the mucosa, acidosis within the mucosa, ischemia of the mucosal nutrition, and the development of reflux gastritis.

　　2. Pathogenesis

　　The normal gastric mucosal surface has a layer of mucus, which has a shielding effect on hydrogen ions, causing gastric acid to remain only in the gastric cavity. When the pyloric defense mechanism against bile reflux is abnormal, bile refluxes into the stomach, and even into the esophagus. The bile acids refluxing into the stomach destroy the barrier function of the mucus layer on the surface of the gastric mucosa, and the mucus layer on the surface of the cells of the gastric mucosa no longer has the functional barrier effect of shielding the reverse diffusion of hydrogen ions and the influx of sodium ions. The result is that bile acids cause the release of histamine in the gastric mucosa, increase the permeability of the gastric mucosa, increase the reverse diffusion of hydrogen ions and sodium ions in the gastric mucosa, edema of the mucosa, acidosis within the mucosa, ischemia of the mucosal nutrition, and the development of reflux gastritis. Some studies have shown that duodenal fluid has a stronger damaging effect on the gastric mucosa than bile alone. Phospholipase A in pancreatic juice hydrolyzes lecithin in bile to produce lysophosphatidylcholine. Bile acids and trypsin activate this reaction. Lysophosphatidylcholine is further hydrolyzed by phospholipase to produce glycerophosphorylcholine and fatty acids. This reaction is then inhibited by bile acids. Lysophosphatidylcholine has a high cytotoxic effect and a damaging effect on the gastric mucosal barrier. In the gastric juice of patients with gastric ulcers, recurrent gastric ulcers, stress ulcers, and post-gastrectomy, the concentration of lysophosphatidylcholine is 10 times higher than that in normal gastric juice, suggesting that lysophosphatidylcholine may play an important role in the pathogenesis of reflux gastritis.

　　1. Some patients may experience symptoms in the throat due to frequent reflux of gastric contents, which can cause throat symptoms: chronic laryngitis, difficulty in speaking, throat pain, periodontitis, etc.

　　Chronic laryngitis is a common laryngeal disease, mainly manifested as chronic inflammatory lesions of the vocal cords and false cords.

　　2. Reflux can lead to many pulmonary diseases such as bronchitis, chronic cough, and aspiration pneumonia.

　　The definition of chronic cough is currently considered to be cough lasting for more than 3 weeks without obvious evidence of pulmonary disease, which is often the only symptom for patients to seek medical attention. Cough is one of the common clinical symptoms of the respiratory system.

　　2 common symptoms of reflux gastritis: upper abdominal pain and bile vomiting.

　　1. 2 common clinical symptoms:Upper abdominal pain and bile vomiting.

　　2. Gastroscopy examination:Pathological biopsy of the gastric mucosa is the most important step in diagnosing reflux gastritis.

　　3. Gastro-esophageal scintigraphy.

　　I. Prognosis:Clinical treatment effects with drugs or surgery are relatively satisfactory.

　　II. Prevention

　　1. The use of Billroth I or Roux-y gastric resection can help prevent bile reflux gastritis and reduce the incidence of residual gastric cancer.

　　1. Do not drink alcohol, do not eat spicy or刺激性 food, eat less greasy food, have regular meals three times a day, especially have breakfast, do not overeat or overdrink.

　　Gastro-esophageal scintigraphy can detect the reflux of radioactively labeled meals, with sensitivity and specificity of about 90%.

　　1. Gastroscopy:Pathological biopsy of the gastric mucosa is the most important diagnostic step for diagnosing reflux gastritis. The endoscopic findings of reflux gastritis show red, congested, edematous mucosa of the corpus or residual stomach, fragile tissue that is prone to bleeding upon contact, superficial ulcers, and submucosal vascular loops visible under endoscopy.

　　2. Specimen microscopic examination:Rare parietal cells, superficial ulcer formation, bleeding, mucosal atrophy, chronic inflammation with lymphocytic infiltration.

　　1. Avoid overeating:Eating too much, with a large amount of food staying in the stomach for a long time, increases the pressure in the stomach.

　　2. Avoid hard foods:Hard foods or indigestible foods (such as fried beans, fried peanuts, fried foods, etc.) can cause mechanical wear on the ulcer surface, causing bleeding or perforation.

　　3. Avoid drinking alcohol:Alcohol can stimulate the gastric mucosal blood vessels, causing spasm and ischemia, and increasing gastrointestinal motility.

　　4. Avoid drinking carbonated water:Sodium bicarbonate dissolved in carbonated water can produce a large amount of carbon dioxide gas, increasing the pressure in the gastrointestinal tract.

　　5. Avoid drinking strong tea and coffee:Strong tea can stimulate the gastric mucosa, causing pain.

　　6. Avoid overly greasy foods:Fried, deep-fried, and high-fat foods are often difficult to digest and increase the burden on the stomach.

　　7. Avoid cold foods:It can stimulate the secretion of gastric acid.

　　8. Avoid emotional changes:Stress or overexertion can lead to disorders of digestive function.

　　9. Avoid overly hot foods:Hot foods can dilate gastrointestinal blood vessels, exacerbating bleeding.

　　10. Avoid sweet foods:Sweet foods can stimulate the gastrointestinal mucosa, causing acid regurgitation and belching, and increasing discomfort.

　　1. Treatment

　　Theoretically, drugs such as cholestyramine (cholestyramine) that combine bile acids are a reasonable choice for the treatment of reflux gastritis. However, in the clinical random, double-blind trial of cholestyramine (cholestyramine) for the treatment of reflux gastritis, there is no difference compared to placebo. Fortunately, some symptoms of patients with reflux gastritis can improve spontaneously. For patients with severe symptoms, long duration, weight loss, malnutrition, gastrointestinal bleeding, and/or small cell anemia, surgical treatment can be considered. The commonly used Roux-Y gastrojejunostomy with vagotomy and jejunojejunal interposition jejunal segment end-to-end anastomosis has achieved remarkable therapeutic effects in the treatment of reflux gastritis.

　　2. Prognosis

　　Clinical treatment effects with drugs or surgery are relatively satisfactory.