Relationship between primary bile reflux gastritis and gastroesophageal reflux disease

AIM: To investigate the relationship between primary bile reflux gastritis (PBRG) and gastroesophageal reflux disease (GERD).

METHODS: A total of 1 060 patients diagnosed with PBRG comprised the observation group, and 1 060 people without PBRG were used as controls. The incidence rate of GERD in the two groups was compared. The patients with PBRG and GERD were divided into mild group, moderate group, severe group based on the severity of PBRG. The degree of esophageal mucosal injury and the distribution of GERD symptoms were then compared.

RESULTS: The incidence rate of GERD in the PBRG group was higher than that in the control group (24.5% vs 9.8%, P < 0.05). The incidence rate of esophageal mucosal injury increased with the aggravation of PBRG. The degree of PBRG showed no significant association with the distribution of GERD symptoms.

CONCLUSION: PBRG has a positive correlation with the formation of reflux esophagitis (RE), and PBRG does not play a major role in producing typical GERD symptoms.

Expression of motilin and vasoactive intestinal peptide in gastric mucosa of patients with primary bile reflux gastritis

AIM: To investigate the expression of motilin and vasoactive intestinal peptide (VIP) in gastric mucosa of patients with primary bile reflux gastritis.

METHODS: Seventy-four patients with primary bile reflux gastric were divided into low reflux group (n = 42) and high reflux group (n = 32). A control group was composed of 28 subjects who showed no abnormalities during 24-hour gastric bilirubin monitoring with Bilitec 2000 and gastroscopic examination. The expression of motilin and VIP in biopsy specimens was detected by immunohistochemistry and analyzed using pathology image analysis software.

RESULTS: The expression levels of motilin in the high and low reflux groups were lower than that in the control group (558.93 ± 223.63 and 787.09 ± 252.97 vs 941.50 ± 275.87, respectively; both P < 0.05), while the expression levels of VIP in the high and low reflux groups were higher than in the control group (1700.06 ± 486.55 and 1241.19 ± 359.34 vs 959.00 ± 335.78, respectively; both P < 0.01). The detection rates of metaplasia atrophy in the high and low reflux groups were higher than that in the control group (50.0% and 26.2% vs 7.1%, respectively; P < 0.01 and 0.05). Patients with metaplastic atrophic gastritis had higher reflux rate than those with superficial gastritis (59.3% vs 30.5%, P < 0.05). The detection rate of Helicobacter pylori (H. pylori) decreased with the aggravation of bile reflux (64.3% and 47.6% vs 25.0%, respectively; P < 0.01 and 0.05).

CONCLUSION: The parasecretion of motilin and VIP may play a role in the development of bile reflux gastritis. Bile reflux is one of the risk factors for gastric mucosa injury. Bile reflux can inhibit the infection of H. pylori.

Pathological features of primary bile reflux gastritis in adolescents: an analysis of 40 cases

AIM: To analyze the pathological features of primary bile reflux gastritis (BRG) in adolescents.

METHODS: Forty adolescents clinically diagnosed with primary BRG by endoscopy and 24-hour gastric pH and bile monitoring were included in the study. Thirty healthy adolescent volunteers were enrolled as controls. Gastric antrum and corpus mucosa biopsy specimens were taken and subjected to routine HE staining and modified Giemsa staining to conduct pathological examination.

RESULTS: Lymphocyte infiltration was mild in BRG adolescents, and grade 2 or less lymphocyte infiltration was noted in 87.5% of patients. Neutrophil infiltration was often concurrent with Helicobacter pylori (H. pylori) infection. Lengthening of gastric pits, trichangiectasia, interstitial edema, mucosal atrophy, intestinal metaplasia and H. pylori infection were observed in 22.5%, 40.0%, 40.0%, 12.5%, 20.0% and 22.5% of patients, respectively. Except intestinal metaplasia and H. pylori infection, the prevalences of other pathological alterations were significantly different between healthy adolescents and BRG adolescents (P < 0.05). Additionally, these pathological alterations were more severe in the antrum than in the corpus.

CONCLUSION: Primary BRG in adolescents shows some features of chemical gastritis and has a tendency to evolve towards mucosal atrophy and intestinal metaplasia.

Expression of ghrelin in gastric mucosa of patients with primary bile reflux gastritis

AIM: To investigate the expression of ghrelin in gastric mucosa of primary bile reflux gastritis.

METHODS: Ninety-six patients with primary bile reflux gastritis at our hospital from June 2007 to November 2007 were divided two groups: low reflux group and high reflux group. Thirty subjects with similar endoscopical findings and without bile reflux were taken as control group. The expression of ghrelin in biopsy specimens were detected by immunohistochemistry.

RESULTS: The expression of ghrelin was lower in the superficial gastritis group, the atrophy group, the intestinal metaplasia group, and the atypical hyperplasia group than in the control subjects (653.822 ± 99.303, 98.913 ± 14.079, 65.875 ± 13.844, 52.290 ± 11.463 vs 884.420 ± 126.362, all P < 0.05). In the superficial gastritis group, the atrophy group and the intestinal metaplasia group, the expression of ghrelin was significantly different between the H pylori positive group and the H pylori negative group (599.320 ± 87.300 vs 721.950 ± 67.836, 47.157 ± 9.582 vs 55.283 ± 11.580, 92.700 ± 10.372 vs 107.600 ± 17.560, all P < 0.05).

CONCLUSION: Bile reflux is a risk factor for gastric mucosa injury. Gastric mucosa atrophy is increased with bile reflux and decreased expression of ghrelin.