Due to the reflux of bile and pancreatic juice into the residual stomach, the gastric mucosa is irritated, leading to gastritis. The incidence rate is higher in Billroth II surgery than in Billroth I surgery.

bubble_chart Diagnosis

Medical history inquiry:

① Persistent burning pain in the mid-upper abdomen or retrosternal burning pain, aggravated after meals, with poor response to antacids.

② Biliary vomiting, often occurring at night, with no relief after vomiting, sometimes accompanied by upper gastrointestinal bleeding, diarrhea, and other symptoms.

Physical examination findings:

Tenderness may be present in the upper abdomen and below the xiphoid process; late stage [third stage] may present with anemia, emaciation, glossitis, and other manifestations.

Auxiliary examinations:

Gastric juice analysis shows achlorhydria. X-ray barium meal examination reveals no evidence of efferent loop obstruction. Gastroscopy shows bile reflux into the stomach, yellow staining of the residual gastric mucosa, and biopsy reveals atrophic changes in the gastric mucosa.

bubble_chart Treatment Measures

Adjust the diet and use metoclopramide 10mg 3 times/day, or domperidone 10mg 3 times/day, or cisapride 5-10mg 3 times/day to promote gastric emptying, reduce bile reflux, and relieve vomiting.

Take cholestyramine 4g one hour before meals or at bedtime for a course of 1-2 weeks, then reduce the dosage for long-term use. Supplement with appropriate amounts of vitamins A, D, K, E, etc. Aluminum hydroxide gel 10ml, three times daily, can alleviate symptoms. If drug treatment is ineffective or bleeding recurs, surgical intervention may be considered.