Q) A 60-year-old woman presents with chronic postprandial epigastric pain, nausea, and bilious vomiting. She had a Billroth II gastrectomy 8 years ago. Despite medical therapy with proton pump inhibitors, sucralfate, and cholestyramine, her symptoms persist. Endoscopy and biopsy confirm ongoing bile reflux gastritis with reactive gastropathy. She is nutritionally declining and has poor quality of life.
What is the most appropriate next step in management?
A. Increase the dose of cholestyramine
B. Add prokinetic therapy (e.g., metoclopramide)
C. Perform total gastrectomy with esophagojejunostomy
D. Convert Billroth II to a Roux-en-Y gastrojejunostomy
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