Scientific paper
Microflora and deconjugation of bile acids in alkaline reflux after partial gastrectomy

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Abstract

It has been postulated that reflux of bile into the stomach promotes gastric carcinogenesis. Bilestained aspirates from 50 asymptomatic patients, partially gastrectomized more than 10 years earlier, were examined bacteriologically and with regard to conjugated and deconjugated bile acids. Endoscopic biopsies showed atrophic gastritis in all patients, cancer in two and severe dysplasia in another two. pH in the reflux aspirates was 7.3 ± 0.4 (mean ± standard deviation). Bacterial cultures were positive in all patients studied. Fecal type flora, mostly E. coli, klebsiella and Clostridium perfringens, was found in 85 percent of the patients. Total bile acids were found to be 2.6 ± 2.0 mg/ml, 23 percent of which were deconjugated. Deoxycholic acid, known to promote carcinogenesis in animals, amounted to 27 percent of total bile acids and deconjugated deoxycholic acid was 5 percent of total bile acids. The mostly anaerobic microflora and the presence of mainly free secondary and primary bile acids may contribute to the high incidence of cancer in the gastric remnant observed after Billroth I or II operations.

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  • Cited by (0)

    This study was supported in part by the Swedish Cancer Society Project 799-B78-05XA, U.S. Public Health Service Grants CA-12376 from the National Cancer Institute and CA-16382 through the National Large Bowel Cancer Project.

    1

    From the Department of Surgery, University Hospital, Umeå, Sweden.

    2

    From the American Health Foundation, Naylor Dana Institute for Disease Prevention, Valhalla, New York.

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