technetium-tc-99m-lidofenin and Vomiting

Frequently, patients present with symptoms after cholecystectomy (pain or discomfort in the upper part of the abdomen, postprandial fullness, bile vomiting, among others). Duodenogastric reflux has been associated with these symptoms in some patients. Therefore, this study was done to investigate this relationship.. We evaluated duodenogastric reflux (DGR) in ten healthy patients, in ten patients who had asymptomatic simple cholecystectomy, in ten patients who had asymptomatic cholecystectomy with supraduodenal choledochoduodenostomy (CD), and in ten patients who had cholecystectomy plus CD followed by discomfort in the upper abdomen, postprandial fullness and bile vomiting, but no colicky pain or acute cholangitis. Duodenogastric reflux was quantified using continuous intravenous infusion of technetium-99m labeled hepatoiminodiacetic acid (99mTc-HIDA) and subsequently determining its concentration in gastric juice.. All of the patients who underwent operation, whatever the technique used, had higher reflux rates than those in the control group (p < 0.001). Moreover, reflux rates were comparable in the patients who underwent simple cholecystectomy compared with patients in the asymptomatic cholecystectomy plus CD group. Conversely, when patients with cholecystectomy plus CD presented with discomfort in the upper part of the abdomen as well as bile vomiting, they had higher reflux rates than patients who underwent simple cholecystectomy (p < 0.001) and asymptomatic patients with associated CD (p < 0.001).. Our results suggest that DGR must be involved in the genesis of these dyspeptic symptoms.

Topics: Abdominal Pain; Bile; Cholecystectomy; Choledochostomy; Duodenogastric Reflux; Dyspepsia; Female; Gastric Juice; Humans; Imino Acids; Infusions, Intravenous; Male; Middle Aged; Organotechnetium Compounds; Radionuclide Imaging; Technetium Tc 99m Lidofenin; Vomiting

One hundred and seven patients with postoperative reflux gastritis treated by Roux-en-Y biliary diversion were reviewed. Three patients died in the postoperative period, and 16 others have since died; cardiorespiratory disease was the most frequent cause of death. Seventy-nine patients were interviewed at a median of 5.5 years (range 0.5-26 years) following Roux-en-Y diversion. At review, a satisfactory result by modified Visick grading was present in 47 per cent of patients. Bilious vomiting (P less than 0.001), food vomiting (P less than 0.01), the severity of upper abdominal pain (P less than 0.001) and heartburn (P less than 0.025) were significantly improved by Roux-en-Y diversion. Weight, haemoglobin levels and employment status were not significantly altered by the procedure. Outcome was related to the surgery preceding Roux-en-Y diversion with significantly better results after partial gastrectomy compared with truncal vagotomy and drainage (P less than 0.01), cholecystectomy (P less than 0.05), or combinations of these procedures (P less than 0.01). Outcome was not predicted by sex, preoperative symptoms, smoking status, consultant surgeon, length of Roux-en-Y or 99Tc-Sn-2,6-di-ethylacetanilidoiminodiacetate (HIDA) scanning results.

Topics: Adult; Aged; Anastomosis, Roux-en-Y; Female; Follow-Up Studies; Gastritis; Humans; Imino Acids; Male; Middle Aged; Organotechnetium Compounds; Postoperative Complications; Radionuclide Imaging; Technetium Tc 99m Lidofenin; Vomiting