Duodenogastric Reflux - Causes, Diagnosis and Treatment.

What Is Duodenogastric Reflux?

Duodenogastric reflux is a mild to moderate condition, and the severity of the situation is correlated with the degree of endoscopic gastritis and other disease processes. The duodenal contents can reflux through the pylorus into the stomach, causing gastric cancer and gastritis. Duodenogastric reflux may generate symptoms of epigastric pain, nausea, and bilious vomiting. Concomitant gastroesophageal reflux can backwash duodenal contents in the lower esophagus and can cause mixed reflux; this can lead to esophageal mucosal damage like adenocarcinoma and Barrett's metaplasia.

What Causes Duodenogastric Reflux?

Duodenogastric reflux is commonly caused by problems with the pyloric valve that is responsible for restricting bile from escaping from the stomach. This can occur due to :

• Surgery: Special stomach surgery and gallbladder removal surgery.

• Impaired Motility: Any delay in the functioning of the pyloric valve and bile flow downwards.

• Obstruction: Obstruction of the pyloric valve by a duodenal ulcer or scar tissue.

What Are the Signs and Symptoms of Duodenogastric Reflux?

Duodenogastric reflux can be difficult to distinguish from gastric acid reflux. The symptoms and signs are similar to them. These symptoms include:

• Nausea.

• Vomiting.

• Occasional hoarseness and cough.

• Severe upper abdominal pain.

• Frequent heartburn.

• Greenish-yellowish fluid in vomit.

• Unintended weight loss.

• Regurgitation.

How Is the Diagnosis Done for Duodenogastric Reflux?

The diagnosis of duodenogastric reflux is always revealed by abdominal symptoms and symptoms associated with the esophagus. Healthcare providers may order a couple of tests to detect abnormalities related to the stomach, esophagus, and upper small intestine. The tests which are performed are:

• Upper Endoscopy Examination: This test involves the usage of a long flexible tube with a camera and a light head that helps to examine and capture images of the internal esophagus and also helps sometimes in taking tissue samples for analysis.

• Hepatobiliary Iminodiacetic Acid (HIDA) Scan: This test procedure is also known as scintigraphy. HIDA scan is a hepatobiliary iminodiacetic acid scan is a radiographic imaging test.

• Esophageal Impedance Test: Acidic or non-acidic content of the esophageal reflex is detected by this test. A small catheter is used, which is placed through the nasal cavity in the esophagus. During this, it measures the episodes of refluxes and the contents of reflux. This is a reliable test to differentiate acidic and non-acidic reflux.

• Bilitec Monitoring System: A photo colorimetric device is used to detect bile content in esophageal reflux.

• Ambulatory Acid Test: An acid-measuring probe identifies long acid refluxes in the esophagus. Ambulatory acid tests can help the health care provider to rule out acid reflux and not bile reflux. A thin flexible tube with a probe is inserted into the nose into the esophagus.

• Bravo Test: Another test called the bravo test is the probe attached to the lower portion of the esophagus that can be done along with endoscopy and the catheter is removed.

What Is the Treatment for Duodenogastric Reflux?

Duodenogastric reflux is treated by a variety of medications that help in curing symptoms and bile reflux. In some cases, symptoms are severe and doctors may recommend surgery.

Medications that are used to treat duodenogastric reflux are :

• Bile Acid Sequestrants: Bile acid sequestrants disrupt and bind the circulation of bile.

• Sucralfate: Helps in protecting the lining of the esophagus and stomach.

• Ursodeoxycholic Acid (UDCA): This medication changes the content of bile present in the stomach.

• Baclofen: It aids in reducing the relaxation of the lower esophageal sphincter.

• Prokinetic Agents: This helps in motility between the small intestine and stomach.

Healthcare providers may recommend surgery if the conditions fail to respond to medications. Some successful surgeries are :

• Anti-Reflux Surgery: It helps to reinforce and strengthen the lower esophageal sphincter. This procedure strengthens the valves and helps in reducing acid reflux.

• Diversion Surgery: It helps to direct bile away from the stomach.

What Are the Home Remedies and Lifestyle Changes Done to Ease Duodenogastric Reflux?

Different from acid reflux, bile reflux is not related to lifestyle factors. Many individuals experience both bile and acid reflux. Lifestyle changes that help in easing duodenogastric reflux are:

• Eat Smaller Meals: More frequent meals reduce pressure on the lower esophageal sphincter, helping in preventing valve opening at the wrong time.

• Stay Upright After a Meal: Lying right after the meal can worsen the symptoms of reflux and staying upright can help the food in the stomach to empty.

• Avoid Food and Beverages: Some beverages and food increase acid production in the stomach and relax the lower esophageal sphincter. Avoid caffeinated and carbonated drinks, citrus foods, vinegar-based dressings, spicy foods, and mint.

• Avoid or Limit Fatty Foods: Fatty foods relaxes the esophageal sphincter and slow the rate of food leaving the stomach.

• Avoid Alcohol: Excess alcohol irritates the esophagus and lower esophageal sphincter.

• Avoid Smoking: Smoking increases stomach acid production and dries saliva that protects the lining of the esophagus.

• Raise Sleeping Posture: Raising the sleeping posture by four to six inches can help in preventing reflux symptoms. Raising your head using blocks and foam pillows can be helpful.

• Lose Excess Weight: Acid reflux and heartburn can occur more if excess weight adds pressure on the stomach.

• Relax: Do not take more stress, this worsens reflux symptoms and slows digestion. Deep breathing, yoga, and meditation may help.

What Are the Possible Complications of Duodenogastric Reflux?

The complications of duodenogastric reflux are:

• Gastritis: Chronic inflammation of the stomach lining.

• Stomach Cancer: Chronic inflammation can lead to stomach cancer.

• Stomach Ulcer: Gastritis can lead to stomach ulcers.

• Barrett’s Esophagus: Ulcers of the esophagus that cause scarring and cellular changes in the esophagus are called Barrett's esophagus.

• Esophagitis: Inflammation of the esophagus.

• GERD: Gastroesophageal reflux disease.

Conclusion:

Individuals with severe excessive duodenogastric reflux suffer from increased fasting and postprandial duodenogastric reflux. In addition, these individuals are more prone to increased intestinal metaplasia, the incidence of gastric polyps in the stomach, and the severity of gastric mucosal inflammation. Complications like gastroesophageal reflux disease (GERD) and Barrett’s esophagus occur in individuals with duodenogastric reflux as both conditions depend on acid and bile reflux.