Alkaline reflux gastritis is a putative postgastrectomy syndrome presumably caused by excessive reflux of upper gastrointestinal content into the residual stomach after operations for peptic ulcer. In this article, the theoretic basis for the existence of such a syndrome is critically examined and found to be wanting in several respects. The diagnosis is therefore one of exclusion. Most nonoperative therapies are only modestly effective, with the possible exception of feeding patients ursodeoxycholic acid. When operation is indicated, the creation of a long-limb (45-cm) Roux-en-Y eliminates reflux. Unfortunately, symptoms are not invariably alleviated. Complications of operation include marginal ulceration and the Roux stasis syndrome.