Background/Aims: Acid and pepsin is well known to induce esophageal mucosal injury, but the role of small intestinal(gastro)esophageal reflux in causing esophageal mucosal injury is unclear. In the patients who had received gastrectomy, the removal of pylorus allows the reflux of duodenal contents into a smaller gastric remnant. Therefore, small intestinal(gastro)esophageal reflux has been implica ted as the cause of esophagitis in gastrectomized patients. The aim of this study was to assess th differences of the small intestinal(gastro)esophageal reflux in patients who received various types of gastrectomy. Methods: We examined the esophageal symptoms, endoscopy and 24 hour ambulatory esophageal bilirubin monitoring in 6 healthy subjects as control and 34 gastrectomized patients (10 Billroth I, 14 Billroth II, 10 total) due to stomach cancer. Results: The esophageal symptoms and pathologic bile reflux were observed more frequently in the patients who received Billroth II and tota gastrectomy than in patients who received Billroth I gastrectomy. Endoscopic esophagitis was more frequent in patients of Billroth II group than the patients of Billroth I group. All patients who had esophagitis or positive symptom index during examination showed pathologic bile reflux. Conclusions: The "alkaline reflux" including pathologic bile reflux and endoscopic esophagitis was observed more frequently in patients who received Billroth II gastrectomy than in patients who received Billroth subtotal gastrectomy. (Kor J Gastroenterol 1999;33:153 - 161)