title: Role of bile reflux and Helicobacter pylori infection on inflammation of gastric remnant after distal gastrectomy.
abstract: OBJECTIVE
  The influence of the main pathogenic factors on remnant gastritis is still to be evaluated. The aim of this study was to investigate the role of bile reflux and Helicobacter pylori infection on endoscopic inflammation and histological changes of gastric remnant after distal gastrectomy.
  
  
  METHODS
  A total of 281 patients with a more than 1-year history of distal gastrectomy were retrospectively involved after excluding those with tumors and ulcers on endoscopy. The severity of endoscopic remnant gastritis and bile reflux were recorded during the endoscopy. The histological changes including chronic inflammation, activity, atrophy, intestinal metaplasia and H. pylori were evaluated independently.
  
  
  RESULTS
  An endoscopic inflammation of remnant gastric mucosae was found in 81.1% (228/281) of the patients. The prevalence of H. pylori infection and bile reflux in patients with endoscopic remnant gastritis was more common than in those without gastritis (21.5%vs 0%, 88.6%vs 24.5%, P < 0.0001). The score of histological chronic inflammation was significantly higher in patients with bile reflux than in those without obvious bile reflux (1.65 vs 1.45, P = 0.02). Chronic inflammation (1.82 vs 1.57), activity (0.78 vs 0.34), atrophy (0.67 vs 0.41) and intestinal metaplasia (0.67 vs 0.27) in H. pylori-positive patients were all significantly more severe than in H. pylori-negative patients.
  
  
  CONCLUSIONS
  Bile reflux and H. pylori infection exacerbates the severity of endoscopic remnant gastritis and chronic histological inflammation.
authors.affiliation: Department of Gastroenterology, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai Institute of Digestive Disease, Shanghai, China.
authors.forename: Xiao Bo
authors.initials: XB
authors.lastname: Li
authors.forename: Hong
authors.initials: H
authors.lastname: Lu
authors.forename: Hui Min
authors.initials: HM
authors.lastname: Chen
authors.forename: Xiao Yu
authors.initials: XY
authors.lastname: Chen
authors.forename: Zhi Zheng
authors.initials: ZZ
authors.lastname: Ge
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001655:Bile Reflux / Q000453:epidemiology / Q000503:physiopathology*; D005260:Female; D005743:Gastrectomy; D005753:Gastric Mucosa / Q000473:pathology; D018530:Gastric Stump / Q000473:pathology*; D005756:Gastritis; D016481:Helicobacter Infections / Q000453:epidemiology / Q000503:physiopathology*; D016480:Helicobacter pylori; D006801:Humans; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D015995:Prevalence