A. I. Cazzato*1, E. C. Lauritano1, G. Vitale1, M. Garcovich1, D. Roccarina1, G. Cammarota1, A. De Lorenzo2, G. B.

Gasbarrini3, A. Gasbarrini1

1Internal Medicine, Gemelli Hospital, 2Neuroscience, Torvergata, 3Internal Medicine, Gemelli hospital, Rome, Italy

Topics: 1.5 Reflux disease, pathogenesis


INTRODUCTION: After cholecystectomy, up to the 47% of patients complain of new or persistent GI symptoms

(epigastric pain, nausea, vomiting, reflux, diarrhea, peptic ulcer or choledocholitiasis). Cholecystectomy seems to

affect upper GI motility through changes in the neurohumoral axis, which may predispose to duodenogastric and

gastroesophageal reflux decreasing antral motility, altering interdigestive motor activity, inducing sphincter of Oddi

disfunction. Bile acids and pancreatic proteolityc enzymes induce a gastric mucosal injury known as alkaline reactive

gastritis. Histological features of consequent alkaline reactive gastritis include foveolar hyperplasia, edema, and

smooth-muscle proliferation in the lamina propria.


AIMS & METHODS: Aim of this study was to evaluate the prevalence of Small Intestinal Bacterial Overgrowth

(SIBO), in patients with evidence of alkaline reactive gastritis due to DGR.Dyspeptic patients with history of

cholecystectomy in the last 10 years were included if with evidence of DGR at endoscopy confirmed at bilimetry

(Bilitec 2000, Medtronic); endoscopic signs of chronic gastritis; histological signs of chronic gastritis and absence of

Helicobacter pylori infection. All pts enrolled underwent glucose breath test (GBT) under standard conditions to detect

SIBO. Diagnosis of SIBO was based on the occurrence of a peak of H2 values more than 12 ppm above the basal

value after 50 gr glucose ingestion. According to the inclusion criteria, 34 consecutive pts (19 F; 15 M; mean age

55±5) were enrolled from the Gastroenterology Unit of the Gemelli Hospital. Besides, 38 healthy volunteers were

used as control group. There were no significant demographic differences between patients and controls.


RESULTS: Twenty-one out of the 34 pts (62%) enrolled showed a positive GBT. One subject among control group

(2.6%) had a pathological GBT. Difference between the two groups was statistically significant. Moreover, pts with

DGR and GBT positive test showed a significantly higher prevalence of heartburn, bloating and diarrhoea.


CONCLUSION: Preliminary results of this study show a high prevalence of SIBO in patients affected by alkaline

reactive gastritis for DGR post-cholecystectomy. SIBO presence seems to be related to part of symptoms pattern

complained by patients in the post-surgical period. Alkaline gastritis, reducing the efficacy of the gastric acid barrier,

may favour bacterial overgrowth into the upper portion of the small bowel. Besides, SIBO has been associated to a disruption of normal GI motor
events (MMCs) that could contribute to DGR pathogenesis. # C. Small bowel diseases 3. Other malabsorption syndromes