Role of bile reflux and Helicobacter pylori infection on inflammation of gastric remnant after distal gastrectomy.
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.
Li
Xiao Bo
XB
Department of Gastroenterology, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai Institute of Digestive Disease, Shanghai, China.
Lu
Hong
H
Chen
Hui Min
HM
Chen
Xiao Yu
XY
Ge
Zhi Zheng
ZZ
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