Bile reflux gastritis and esophagitis in patients without prior gastric surgery, with pilot study of the therapeutic effects of metoclopramide.

We reviewed our upper endoscopic records over a 27-month period, retrospectively for 23 months and prospectively for four months and identified patients with substantial bile reflux. Patients with prior gastrectomies were excluded. Of the remaining 36 patients, 23 had prior cholecystectomies. Bile reflux gastritis and esophagitis were found in the majority of patients with bile reflux and occurred more often than is generally appreciated. Patients were seen with a fairly consistent and protracted clinical pattern, usually with severe early postprandial epigastric pain, tenderness and frequent heartburn. Cholecystectomy appeared to be a most important predisposing factor. The correct diagnosis can only be made by upper gastrointestinal endoscopic inspection and biopsies. A pilot therapeutic trial of metoclopramide suggests beneficial effects of this drug in the majority of afflicted patients. A randomized controlled trial of metoclopramide is being prepared to define more clearly the role of this drug in bile reflux gastritis and esophagitis.