title: Helicobacter pylori may induce bile reflux: link between H pylori and bile induced injury to gastric epithelium.
abstract: Helicobacter pylori and duodenogastric reflux are both recognised as playing aetiological roles in chronic gastritis. This study investigated whether H pylori colonisation of the antral mucosa and duodenogastric reflux are independent phenomena or have a causal relationship. Thirty eight patients (15 men, 23 women) aged (mean (SD)) 48 (17) years participated. Each patient underwent gastroscopy. Antral biopsy specimens were taken to investigate H pylori colonisation. In addition BrIDA-99mTc/111In-DTPA scintigraphy was used to quantify duodenogastric reflux. H pylori positive patients who were found to have duodenogastric reflux were treated with amoxycillin (1 g/d) and metronidazole (1.5 g/d) for seven days and four tablets of bismuth subcitrate daily for four weeks. Follow up antral biopsies and scintigraphy were repeated at six months. Duodenogastric reflux could not be found in 18 patients, including eight (44%) who were H pylori positive. Ten of the 11 patients who had duodenogastric reflux (reflux % 11.6 (9.2)), however, were H pylori positive (chi 2 = 6.26, p = 0.01). These 10 patients were given eradication treatment. At six months, in six patients who became H pylori negative, duodenogastric reflux was significantly reduced from a pretreatment value of 14.3% to 3.3% (two tail, paired t = 2.57, p = 0.016). These data suggest that H pylori may induced duodenogastric reflux which may be important in the pathogenesis of H pylori gastritis or carcinogenesis, or both.
authors.affiliation: Second Department of Internal Medicine, Athens University, Evangelismos Hospital, Greece.
authors.forename: S D
authors.initials: SD
authors.lastname: Ladas
authors.forename: J
authors.initials: J
authors.lastname: Katsogridakis
authors.forename: H
authors.initials: H
authors.lastname: Malamou
authors.forename: H
authors.initials: H
authors.lastname: Giannopoulou
authors.forename: M
authors.initials: M
authors.lastname: Kesse-Elia
authors.forename: S A
authors.initials: SA
authors.lastname: Raptis
mesh_terms: D000328:Adult; D000368:Aged; D000814:Aniline Compounds; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D004383:Duodenogastric Reflux / Q000150:complications / Q000382:microbiology*; D005260:Female; D005753:Gastric Mucosa / Q000000981:diagnostic imaging; D005998:Glycine; D016481:Helicobacter Infections / Q000150:complications* / Q000188:drug therapy; D016480:Helicobacter pylori / Q000187:drug effects / Q000502:physiology*; D006801:Humans; D007098:Imino Acids; D007205:Indium Radioisotopes; D008297:Male; D008875:Middle Aged; D015609:Organotechnetium Compounds; D011446:Prospective Studies; D011877:Radionuclide Imaging
chemical_list: D000814:Aniline Compounds; D000900:Anti-Bacterial Agents; D007098:Imino Acids; D007205:Indium Radioisotopes; D015609:Organotechnetium Compounds; C034837:technetium Tc 99m mebrofenin; D005998:Glycine