title: Bile reflux index after therapeutic biliary procedures.
abstract: BACKGROUND
  Therapeutic biliary procedures disrupt the function of the sphincter of Oddi. Patients are potential "bile refluxers". The aim of this study was to assess how these procedures affect the histology-based bile reflux index (BRI), which can be used to reflect duodenogastric reflux (DGR).
  
  
  METHODS
  Gastric antrum and corpus biopsies were collected from 131 subjects (56 men, 75 women; mean age, 55.9 +/- 15.6 years). Group 1 (Biliary group-BG; n = 66) had undergone endoscopic sphincterotomy, endoscopic stenting, or choledochoduodenostomy for benign pathology; Group 2 (n = 20) had undergone cholecystectomy alone; and Group 3 (n = 6) Billroth II gastroenterostomy. Group 4 (no cholecystectomy; n = 39) had upper endoscopy with normal findings and served as controls. BRI > 14 indicated DGR (BRI [+]). To eliminate confounding effects of Helicobacter pylori (Hp) infection, comparisons were made according to Hp colonization.
  
  
  RESULTS
  Fifty-nine subjects (45%) were Hp (+). The frequencies of BRI (+) status in antrum and corpus specimens from Hp (-) BG patients were 74.3% and 71.4%, respectively (85.7% for both antrum and corpus for choledochoduodenostomy). Corresponding results were 60% and 60% for Group 2, 100% (only corpus) for Group 3, and 57.1% and 38.1% for controls (BG, Group 2, and Group 3 vs controls - p > 0.05 antrum, p < 0.05 corpus). Fifty-four BG patients had previously undergone cholecystectomy. Excluding those, the rates of BRI (+) in Hp (-) BG patients were 75% antrum and 62.5% corpus (p > 0.05 for both vs. Group 2).
  
  
  CONCLUSIONS
  Patients who had undergone biliary procedures showed similar bile-related histological changes in both corpus and antrum biopsies, but the changes seen in controls were more prominent in the antrum than corpus. Therapeutic biliary procedures increase the rate of BRI (+) especially in the case of choledochoduodenostomy. Therapeutic biliary procedures without cholecystectomy also increase the rate of BRI (+) similar to that observed in patients with cholecystectomy.
authors.affiliation: Gastroenterology Department, Turkiye Yuksek Ihtisas Hospital, Ankara, Turkey. sedefozdal@hotmail.com
authors.forename: Sedef
authors.initials: S
authors.lastname: Kuran
authors.forename: Erkan
authors.initials: E
authors.lastname: Parlak
authors.forename: Gulden
authors.initials: G
authors.lastname: Aydog
authors.forename: Sabite
authors.initials: S
authors.lastname: Kacar
authors.forename: Nurgul
authors.initials: N
authors.lastname: Sasmaz
authors.forename: Ali
authors.initials: A
authors.lastname: Ozden
authors.forename: Burhan
authors.initials: B
authors.lastname: Sahin
mesh_terms: D000328:Adult; D000368:Aged; D001662:Biliary Tract Surgical Procedures; D002763:Cholecystectomy; D002768:Choledochostomy; D004383:Duodenogastric Reflux / Q000453:epidemiology* / Q000382:microbiology / Q000503:physiopathology; D005260:Female; D016480:Helicobacter pylori / Q000302:isolation & purification; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011706:Pyloric Antrum / Q000382:microbiology / Q000473:pathology*; D012307:Risk Factors; D009803:Sphincter of Oddi / Q000503:physiopathology; D016717:Sphincterotomy, Endoscopic; D013270:Stomach / Q000473:pathology*