Bile reflux gastritis after gastrectomy

　　Gastric surgery, such as the resection of the pylorus or the transection of the vagus nerve trunk, leads to the loss of neural control of the pylorus, significantly increasing the opportunity for duodenal contents to reflux into the stomach. The bile acids can dissolve lipoproteins and destroy the protective barrier of the gastric mucosa, with H+ entering the gastric cavity. H+ then enters the gastric mucosa. The H+ entering the gastric mucosa can stimulate mast cells to release histamine. The latter then stimulates the secretion of gastric acid and pepsin, further aggravating the damage to the gastric mucosa and producing inflammation, erosion, and ulcers. The pancreatic juice in the duodenal fluid has a synergistic effect on the damage to the gastric mucosa. In addition, gastric surgery, especially Billroth II surgery, strengthens the gastric mucosal barrier, reduces the secretion of gastrin that can resist the reverse diffusion of H+, weakening the barrier function of the gastric mucosa, which is also one of the factors contributing to the onset of reflux gastritis.

　　Specifically, the causes of bile reflux gastritis include:

　　1. After a subtotal gastrectomy, the pyloric sphincter is removed, losing the structure to prevent bile reflux.

　　2. Pyloric sphincter dysfunction, with the pylorus in an open state, the duodenum is more unobstructed, leading to bile reflux into the stomach. This condition is common among patients. Or due to Helicobacter pylori infection, leading to pyloric inflammation, edema, and infection, and the dysfunction of the pyloric sphincter.

　　Gallstones, long-term smoking, drinking, high-fat diet, and other factors can also cause bile reflux.

　　In addition to causing complications such as esophageal stenosis, hemorrhage, and ulcers, the refluxed gastric juice can also erode the pharynx, vocal cords, and trachea, causing chronic pharyngitis, chronic laryngitis, and tracheitis, which are clinically known as Delahunty syndrome. Gastric juice reflux and aspiration into the respiratory tract can also cause aspiration pneumonia.

　　1. Persistent burning pain in the upper middle abdomen or behind the sternum, worsening after meals, and the effect of acid-suppressing agents is not significant.

　　2. Biliary vomiting often occurs at night, and the symptoms do not alleviate after vomiting, and food may be present in the vomit.

　　3. There may be symptoms of chronic atrophic gastritis such as anemia, emaciation, glossitis, and diarrhea.

　　1. Why does bile reflux occur:

　　Under normal circumstances, the pylorus is contracted and closed. When food in the stomach is discharged into the duodenum through peristalsis, the pylorus dilates and opens, and after the food is emptied, the pylorus contracts and closes again, thus preventing bile from refluxing into the stomach. However, when the following conditions occur, such as after partial gastrectomy, after vagotomy and pyloroplasty, after gastrojejunal anastomosis, after cholecystectomy, congenital incomplete closure of the pylorus, and physiological degenerative changes in middle-aged and elderly organs, the 'guarding' function of the pylorus can be destroyed, and bile reflux can occur.

　　2. How does bile reflux cause damage to the gastric mucosa:

　　When bile reflux (more accurately, the reflux of duodenal fluid mixed with bile) occurs, bile in the duodenal fluid (containing bile acid), pancreatic enzymes, lecithin, and other substances can destroy the protective barrier function of the gastric mucosa. The reason is that bile acid can dissolve the mucus in the stomach (which has a protective effect on the gastric mucosa) and destroy the superficial mucosal cells, thereby causing direct stimulation of the gastric mucosa and causing damage; the bile entering the stomach can also activate lecithin A, changing lecithin into lysophosphatidylcholine and destroying the cell membrane; in addition, when the alkaline duodenal fluid neutralizes the acidic gastric juice, the gastric antrum pH value (acidity and alkalinity) approaches neutral, it can activate pancreatic enzymes to cause damage to the gastric mucosa. Moreover, the incidence of this disease after cholecystectomy also increases (some reports indicate that 60% of patients with this disease have a history of cholecystectomy), which is related to the continuous inflow of bile into the duodenum for 24 hours a day (when the gallbladder is normal, bile enters the duodenum at regular intervals after meals).

　　Gastric juice analysis shows a lack of gastric acid, X-ray barium meal examination shows no obstruction of the output loop, gastroscopy shows bile reflux into the stomach, the residual gastric mucosa is yellowish, and biopsy shows the gastric mucosa presents atrophic changes.

　　First, the dietetic recipe for bile reflux gastritis:

　　1. Osmanthus Core Porridge

　　50 grams of glutinous rice, 2 grams of osmanthus core, 2 grams of Poria cocos. Rinse the glutinous rice clean. Put the osmanthus core and Poria cocos in the pot, add an appropriate amount of water, bring to a boil with strong fire, then turn to a low fire and boil for 20 minutes, filter the residue, and leave the juice. Put the glutinous rice and the juice in the pot, add some more water, bring to a boil with strong fire, then turn to a low fire and cook until the rice is soft and becomes porridge. Take once a day, before and after meals.

　　2, Fresh Lotus Root Porridge

　　An appropriate amount of fresh lotus root, 100 grams of glutinous rice, a little brown sugar. Clean the fresh lotus root, cut it into thin slices, and clean the glutinous rice. Put the glutinous rice, lotus root slices, and brown sugar in a pot, add a suitable amount of water, boil over high heat, then simmer over low heat until the rice is cooked into porridge. Eat twice a day, at breakfast and dinner.

　　3, Orange Honey Drink

　　1 orange, 50 grams of honey. Soak the orange in water to remove the sour taste, then cut it into 4 pieces with the peel on. Put the orange and honey in a pot, add a suitable amount of water, boil over high heat, then simmer over low heat for 20-25 minutes. Remove the orange and keep the juice.

　　4, Goji and Lotus Root Starch Soup

　　25 grams of goji berries, 50 grams of lotus root starch. First, boil the lotus root starch with a suitable amount of water over low heat. Then, add goji berries and boil again. It can be eaten.

　　5, Tangerine Peel Congee

　　25 grams of fresh tangerine peel, 50 grams of glutinous rice. First, wash the fresh tangerine peel, cut it into pieces, and cook it with the glutinous rice. Eat when the glutinous rice is done.

　　6, Honey Peach Juice Drink

　　20 grams of honey, 1 fresh peach. First, peel and pit the peach, then press it into juice. Add honey and a suitable amount of warm water.

　　7, Carrot and Dried Tangerine Peel Stir-Fried Lean Pork Strips

　　Ingredients: 200 grams of carrots, 10 grams of dried tangerine peel, 100 grams of lean pork.

　　Preparation: Cut carrots into strips, mix pork strips with salt and yellow wine, and soak dried tangerine peel until soft and cut into strips. First, fry the carrots until they are done and remove them from the pan. Then, fry the pork strips and dried tangerine peel for 3 minutes with oil, add the carrot strips, a little salt, and yellow wine, and stir-fry until dry. Add a small amount of water and simmer for 3-5 minutes, then add chopped scallions.

　　Effects: Expand the chest and regulate Qi.

　　8, Clove Duck

　　Ingredients: 5 grams of cloves, 5 grams of cinnamon, 5 grams of galangal, 1 duck (about 1000 grams).

　　Preparation: Clean the duck, boil 3500 milliliters of water with cloves, cinnamon, and galangal twice, each for 20 minutes. Filter the juice, about 3000 milliliters, and pour it into a pot. Add the duck, scallions, and ginger, and cook over low heat until it is seven-sevenths done, then remove and cool. Put the brine in the pot, cook the duck in the brine until done, remove it, add 10 grams of rock sugar and a little salt and MSG to the brine, add the duck back, and cook while rolling and pouring the brine over it. Remove when the skin is bright red, and spread sesame oil on it.

　　Effects: Temper the middle-jiao, relieve pain.

　　9, Dried Tangerine Peel Oil-Braised Chicken

　　Ingredients: 1 rooster (about 1500 grams), 20 grams of dried tangerine peel.

　　Preparation: Boil 1000-1500 milliliters of clean water, add half of the dried tangerine peel, ginger, scallions, Sichuan peppercorns, and a small amount of salt. Put the cleaned chicken in and cook until it is six-sevenths done, then remove it. Pour the brine into the pot, bring to a boil, add the chicken back, and cook over low heat until done, then remove and set aside. Keep a little brine in the pot, add 10-30 grams of rock sugar and a little MSG and salt, and reduce to a sauce. Spread the sauce on the surface of the chicken. Heat vegetable oil in the pot, fry the remaining dried tangerine peel into strips until crispy. Hold the chicken upside down and repeatedly pour hot oil over it until the color is bright red. Then, spread sesame oil on the surface of the chicken, cut it into small pieces, arrange on a plate, and sprinkle with the crispy dried tangerine peel strips.

　　Effect: Promoting Qi and opening the stomach.

　　10. Two Green Teas

　　Formula: Green萼梅6 grams, green tea 6 grams.

　　Preparation: Boil the two ingredients in hot water for 5 minutes.

　　Effect: Relieving liver Qi and stopping stomachache.

　　Two. Foods that are good for bile reflux gastritis:

　　1. Prefer low-fat high-protein diet, such as milk, beans, and fish.

　　2. Eat more foods that protect the digestive system function, such as beets, myrica, yam, coix seed, radish, etc.

　　3. Eat some yellow fruits: Yellow fruits have a high content of carotenoids and have antioxidant physiological activity, such as oranges, mangoes, persimmons, and apricots contain β-carotene, papayas, watermelons, and red grapefruits contain lycopene.

　　4. Eat more light and nutritious foods, such as fish, lean meat, protein, tofu, etc.

　　Three. Foods that should not be eaten with bile reflux gastritis:

　　1. Do not eat greasy foods to avoid increasing bile secretion and aggravating reflux and the condition.

　　2. Avoid cold and raw foods. Eating too much cold and raw food can lead to coolness in the chest and abdomen, blood and Qi stasis, vomiting of clear water or sour water, and exacerbation of stomachache. Avoid drinking soda, cola, and eating spicy and刺激性 foods.

　　3. Avoid eating large amounts of meat and fried foods. Because large amounts of meat and fat are difficult to digest and absorb, they are prone to induce stomachache.

　　4. Avoid smoking and drinking. Excessive drinking can cause the gastric mucosa to become congested and swollen, even eroded, leading to acute gastritis. Long-term drinking of strong alcohol can cause serious damage to the gastric mucosal cells, significantly increasing the incidence of chronic gastritis. The harmful components in tobacco can increase gastric acid secretion and stimulate the gastric mucosa. Excessive smoking can also lead to dysfunction of the pyloric sphincter, causing bile reflux and damaging the gastric mucosa. According to the survey, 40% of those who smoke more than 20 grams a day will develop gastric mucosal inflammation.

　　1. Avoid greasy and overeating, and prefer to eat small and frequent meals.

　　2. Eliminate certain factors that exacerbate the condition, including quitting smoking, avoiding emotional tension, and not taking drugs that irritate the gastric mucosa.

　　3. Psychological adjustment is very important. In the group of people with stomach diseases, bile reflux gastritis is very common, often seen in patients who have had a partial gastrectomy, patients with gallstones and cholecystitis, and patients with peptic ulcers.