Bile reflux and intestinal metaplasia in gastric mucosa.
OBJECTIVE
To determine associations between enterogastric bile reflux and gastric mucosal pathology.


METHODS
A retrospective study using fasting gastric juice bile acid measurements and antral or prestomal biopsy specimens from 350 patients, 66 of whom had previously undergone surgery that either bypassed or disrupted the pyloric sphincter.


RESULTS
Bile reflux was positively associated with reactive gastritis and negatively with Helicobacter pylori density. After stratification for previous surgery, age, and H pylori status, the histological feature most strongly associated with bile reflux was intestinal metaplasia, including all its subtypes. The prevalence of intestinal metaplasia was greatest in patients with both H pylori infection and high bile acid concentrations. Bile reflux was also positively associated with the severity of glandular atrophy, chronic inflammation, lamina propria oedema and foveolar hyperplasia.


CONCLUSIONS
Bile reflux is a cause of reactive gastritis. It modifies the features of H pylori associated chronic gastritis. The changes are not confined to patients who have had surgery to their stomachs. The positive associations with atrophy and intestinal metaplasia have implications for models of gastric carcinogenesis.
Sobala
G M
GM
Centre for Digestive Diseases, General Infirmary, Leeds, West Yorkshire.
O'Connor
H J
HJ
Dewar
E P
EP
King
R F
RF
Axon
A T
AT
Dixon
M F
MF
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001647:Bile Acids and Salts / Q000032:analysis; D001655:Bile Reflux / Q000150:complications / Q000473:pathology*; D005260:Female; D005750:Gastric Juice / Q000737:chemistry; D005753:Gastric Mucosa / Q000382:microbiology / Q000473:pathology*; D005756:Gastritis / Q000209:etiology; D016481:Helicobacter Infections; D016480:Helicobacter pylori / Q000302:isolation & purification; D006801:Humans; D008297:Male; D008679:Metaplasia / Q000473:pathology; D008875:Middle Aged; D015995:Prevalence; D012189:Retrospective Studies; D013270:Stomach / Q000473:pathology
D001647:Bile Acids and Salts