| Abstrakt: |
Increased duodenogastric reflux has been recognized as a cause of gastric mucosa damage. The frequent finding of bile-stained gastric juice and a suggested higher frequency of lesions of the gastric mucosa in patients with Chagas' disease, which is characterized by a marked reduction of myenteric neurons, suggest that impairment of intrinsic innervation of the gut might be associated with increased duodenogastric reflux. Duodenogastric bile reflux was quantified after intravenous injection of99mtechnetium-HIDA, in 18 patients with chronic Chagas' disease, 12 controls, and 7 patients with Billroth II gastrectomy. All but one of the chagasic patients were submitted to upper digestive tract endoscopy. High reflux values (?10%) were detected both in chagasic patients and in the controls, but the values for both groups were significantly lower (P< 0.01) than those obtained for Billroth II patients (median: 55.79%; range: 12.58– 87.22%). Reflux values tended to be higher in the Chagas' disease group (median: 8.20%; range: 0.0– 29.40%) than in the control group (median: 3.20%; range: 0.0– 30.64%), with no statistical difference between the two groups (P>0.10). Chronic gastritis was detected by endoscopy in 12 chagasic patients, benign gastric ulcer in 2 patients, and a pool of bile in the stomach in 11 patients. However, neither the occurrence of gastric lesions nor the finding of bile-stained gastric juice was associated with high reflux values after [99mTc]HIDA injection. This study suggests that lesions of the intramural nervous system of the gut in Chagas' disease do not appear to be associated with abnormally increased duodenogastric reflux. |
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