A Simple Method for the Quantification of Biliary Reflux

Abstract

^99mTc-diethyl-IDA is completely excreted into the bile. When cholecystokinin is given after priming of the biliary tract with this tracer, gallbladder contraction leads to expulsion of bile into the duodenum. At the same time cholecystokinin causes contraction of the pylorus, which should normally prevent substantial reflux of tracer into the stomach. We have applied these physiological characteristics in a method to quantify biliary gastric reflux. Fourteen controls had a median reflux of 4.3% of the intravenous dose (93% of controls had values <9%). In 18 patients with Billroth II gastrectomies the median reflux was 46% (p < 0.001). Patients with chronic gastritis (no. = 18) had also increased reflux (median 18.1%, p < 0.001). The same was found in gastric ulcer (no. = 18, median 11.8%, p < 0.003). In duodenal ulcer (no. = 7) increased reflux existed in only two patients with pyloric deformation. Patients with hiatal hernia did not show increased reflux (no. = 10, median 2.2%). Bilirubin measurements tended to underestimate reflux in pathological cases, whereas bile acid measurements and reflux percentages of tracer showed a close relationship (r = 0.87, p< 0.001).

Key-words:

• Biliary reflux
• Billroth II gastrectomies
• ^99mTc-diethyl-IDA
• duodenal ulcer
• gastric ulcer
• gastritis
• oesophagitis