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primary bile reflux gastritis

Sunday 10 February 2013

Bile reflux is one of the primary factors involved in the pathogenesis of gastric mucosal lesions in patients with chronic gastritis.

Foveolar hyperplasia was associated with the severity of bile reflux, suggesting that it is a histological feature of primary BRG in children, while vascular congestion may be a protective factor.

In addition to gastric acid and Helicobacter pylori (HP), bile reflux is one of the primary factors involved in the pathophysiological processes leading to gastric mucosal lesions in patients with chronic gastritis; however, little is known about the exact histological features of bile reflux and its contributions to gastric mucosal lesions in this disease.

When duodenal contents reflux into the stomach for a short period during a physiological event, it causes few symptoms. However, duodenogastric reflux (DGR) becomes pathological when it is excessive or lasts for an extended period of time. Bile reflux gastritis (BRG) is due to an excessive reflux of bile, pancreatic and intestinal secretions into the stomach.

The increased bile reflux may cause increased gastric mucosal injury.

Primary BRG is defined as bile reflux-induced gastritis without a prior stomach surgery. Excessive DGR is very common in adults after gastric surgery, pyloroplasty, and cholecystectomy.

Dixon et al. first reported the histological findings of bile reflux gastritis induced by DGR after a partial gastrectomy. They proposed a scoring system based on five characteristic histological features, including:
- antral foveolar hyperplasia,
- antral mucosal congestion (vascular congestion)
- antral mucosal edema
- smooth muscle fibers in the lamina propria
- paucity of chorionic inflammatory cells

The authors revealed significant associations between the histologic findings and hypochlorhydria and increased gastric bile acid concentration. However, a partial gastrectomy is not the only cause of BRG; similar changes have been reported in the intact stomach.

There are many reports of BRG in adults, but the histological features of gastric mucosa in children with primary BRG remain unclear.

Synopsis

- antral foveolar hyperplasia,
- antral mucosal congestion (vascular congestion)
- antral mucosal edema
- smooth muscle fibers in the lamina propria
- paucity of chorionic inflammatory cells

Open References

- Histological features of the gastric mucosa in children with primary bile reflux gastritis. Zhang Y, Yang X, Gu W, Shu X, Zhang T, Jiang M. World J Surg Oncol. 2012 Jan 31;10:27. doi : 10.1186/1477-7819-10-27 PMID: 22289498 [Free]