XXXX . An objective assessment of its diagnosis and treatment.

@entity1 @entity390 @entity294 @entity8243 @entity3621 @entity158 @entity6744 @entity3645
The hypothesis that reflux of upper intestinal content, particularly of @entity3645 (BA), is responsible for a unique postgastrectomy syndrome, @entity3621 , was tested on 28 occasions in 21 postoperative @entity1 (14 symptomatic @entity1 , 7 controls). Parameters evaluated: recumbent (rec.), upright, p.c. intragastric pH, {BA}, net BA reflux per hour, specific BA fractions, fasting and p.c. @entity8243 , maximal acid output (MAO), gastric emptying of solids by delta-scintigraphy), and the severity of nonstomal histologic @entity3621 , the " @entity3621 score," graded 0-15 by an independent senior pathologist. For the entire group, @entity3621 severity correlated positively with intragastric {BA} and net BA reflux per hour, both in recumbency and p.c. Five symptomatic @entity1 demonstrated rec. and p.c. {BA} and net BA reflux per hour greater than two standard deviations from comparable mean values in control @entity1 . They differed significantly from the remaining symptomatic @entity1 as follows: increased intragastric {BA} and net BA reflux per hour, increased intragastric pH and decreased MAO. They also demonstrated a more severe grade of @entity3621 . @entity6744 was present in their reflux content significantly more often. Bilious vomiting was also more frequent. No other differences could be identified, either objectively or clinically, between the symptomatic groups. Four @entity1 with excessive reflux underwent Roux-en-Y revision and restudy 6-22 months later. BA reflux was completely abolished, histologic @entity3621 improved, hematocrit rose, MAO increased, and gastric emptying slowed. Burning @entity158 , and symptoms of esophageal reflux were eliminated. Vomiting and @entity390 were improved. @entity294 was unchanged. The objective criteria outlined can identify symptomatic postgastrectomy @entity1 with a greater than normal reflux and @entity3621 . Clinical criteria alone cannot. Revisional surgery in these @entity1 eliminates reflux, improves @entity3621 , and produces symptomatic improvement. The hypothesis under consideration is strengthened but not proven.
