Reflux of bile and pancreatic fluid into the stomach after gastric surgery can result in a gastritis.


Risk factors:

(1) Billroth II anastomosis

(2) cholecystectomy


Clinical findings:

(1) Burning epigastric pain is present and may be continuous.

(2) The epigastric pain may not relieved by food or antacids.

(3) nausea

(4) anorexia with weight loss

(5) anemia from chronic blood loss and/or iron deficiency

(6) bilious vomiting

(7) early postprandial dumping may occur


Gastric biopsy shows a chronic gastritis that is negative for Helicobacter pylori. This is often nonspecific, but occasionally bile pigment can be seen.


HIDA scan shows reflux of bile into the stomach.


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