MGB/BILLROTH II - REFLUX - CANCER

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Duodenogastric reflux and gastric mucosal polyamines in the non-operated

stomach and in the gastric remnant after Billroth II gastric resection.

A role in gastric carcinogenesis?

Anticancer Res 2000 May-Jun;20(3B):2197-201 (ISSN: 0250-7005)

Lorusso D; Linsalata M; Pezzolla F; Berloco P; Osella AR; Guerra V; Di

Leo A; Demma I

Department of Surgery, Scientific Institute for Digestive Diseases S. De

Bellis, Castellana Grotte, Bari, Italy.

BACKGROUND: The relationship between bile reflux and gastric cancer is

not defined. In order to verify whether a relationship exists, we

evaluated the duodenogastric reflux and the mucosal polyamines

concentration, polycation compounds actively involved in cell

proliferation, in the non-operated stomach and in gastric remnant after

Billroth II gastric resection, a precancerous condition.

MATERIALS AND METHODS: The study was performed on three groups of

subjects: A) 43 subjects with slight dispeptic symptoms, never operated

on; 54 cholecystectomized subjects; C) 38 subjects operated on

Billroth II gastric resection for duodenal ulcer. Duodenogastric reflux

was assessed by measuring the concentration of bile acids in gastric

juice and expressed as Fasting Bile Reflux in micromol/hour. Gastric

mucosal polyamine concentration was assessed by High Performance Liquid

Chromatography and expressed in nmol/mg of proteins.

RESULTS: The lowest levels of Fasting Bile Reflux (7.95 micromol/hour)

and polyamines (7.09 nmol/mg proteins) were observed in subjects never

operated on. The middle values were present after cholecystectomy

(Fasting Bile Reflux = 18 micromol/hour; polyamines = 8.14 nmol/mg

proteins). The highest values were observed after Billroth II gastric

resection (Fasting Bile Reflux = 830 micromol/hour; polyamines 11.74

nmol/mg proteins) (Kruskal-Wallis test, p = 0.0001). There was a

positive correlation between Fasting Bile Reflux and polyamines

(Spearman's rank = 0.33; p = 0.0008).

CONCLUSIONS: High levels of duodenogastric reflux observed after

Billroth II gastric resection are associated with high polyamine

concentration in the gastric mucosa. Bile reflux can be considered an

important causal factor of the increased risk of gastric stump cancer

after Billroth II gastric resection.

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