Intragastric Alkali Infusion

Abstract

Alkaline reflux gastritis is a disabling clinical syndrome, occurring most often after gastric surgery. It is characterized by abdominal pain and bilious vomiting and presumably is due to gastric irritation by regurgitated duodenal contents. The only known effective treatment is by surgical diversion to prevent the duodenal reflux. The clinical diagnosis is difficult to prove and the results of surgery are too often disappointing because of inaccurate patient selection. A new test for distinguishing patients with symptomatic bile reflux gastritis is presented. The test consists of blind sequential infusion into the stomach, via nasogastric tube, of 20 ml of 0.1 N HCl, normal saline, 0.1 N NaOH and the patient''s own gastric contents. Each solution is given twice. A positive test is defined as reproduction of the patient''s usual pain by NaOH and/or gastric contents, but not by acid or saline. Fifteen of 21 patients with clinical symptoms and endoscopic findings suggesting bile gastritis had a positive alkali infusion test, while only 1 of 18 normal controls and 0 of 17 controls with other causes of abdominal pain had a positive test (P < 0.001). Of the 21 patients with clinical-endoscopic bile gastritis, 15 have had surgical treatment by Roux-en-Y gastrojejunostomy. Nine of 10 patients with a positive test had excellent symptomatic relief after surgery. Zero of 5 patients with a negative test were relieved of pain after the operation. This simple test is apparently a sensitive, specific and accurate means for selecting patients for surgical treatment of alkaline reflux gastritis.