Postoperative alkaline reflux gastritis.

1. The syndrome of reflux gastritis is produced by the actions of bile and upper intestinal and pancreatic secretions alone or in combination on an altered gastric mucosa. 2. The triad of epigastric pain unrelieved by antacids, bilious vomiting, and weight loss, particularly after a gastric operation should make one suspect this syndrome. Anemia due to loss of blood and dysphagia occur less frequently. 3. The definitive diagnosis is made by endoscopy. Barium studies are of less value. Acid secretory studies are not diagnostic and are of academic interest. 4. Medical treatment utilizes antacids and cholestyramine alone or together. Good, long-lasting results with these are infrequent. Despite these results, medical treatment should be tried first. 5. Surgical treatment consists of diversion of the biliary and upper intestinal secretions from the stomach and doing a vagotomy with or without a distal gastric resection to prevent a marginal ulcer from developing. 6. The two most popular operations are a Roux-en-Y diversion or interposed peristaltic jejunal limb. The simplicity of the former has made this more popular with most American surgeons. 7. The results of surgery are good to excellent in 75 to 95 per cent of cases. Relief of symptoms, improvement in histologic and secretory studies, and weight gain should be anticipated. 8. Less than optimal results are reported when the surgical diversion has not been total, gastric stasis persists, or other postgastrectomy sequelae accompany reflux gastritis.