Pathogenic factors of primary pathological duodenogastric reflux

Objective To study the relationship among the gastric mucosal lesions caused by primary pathological duodenogastric reflux,the Hp infection,the bile reflux assessed with bilirubin absorbance.Methods 24 hours intragastric bile reflux of 86 cases in primary pathological duodenogastric reflux were measured using Bilitec 2000.Endoscopy and gastric mucosa biopsies were performed in all cases for examination with rapid urease test,improved Giemsa staining and HE staining in order to diagnose Hp infection and define the lesions of gastric mucosa.The degree of chronic inflammation,activity,atrophy,intestinal metaplasia of gastric mucosa were observed.Results ① All cases were divided into two groups,Hp positive group and Hp negative group,based on the diagnosis of Hp infection.The time percentage of bilirubin absorbance≥0.25 in Hp positive group was significantly lower than that in Hp negative group(P0.05).The time percentage of bilirubin absorbance≥0.25 was positively correlated with New Sydney system pathological scores of gastric antrum and gastric anguli in two groups.②Based on the severity of bile reflux,all cases were divided into two groups,high reflux group and low reflux group.Hp infection rate in high reflux group was significantly lower than that in low reflux group(P0.05).The frequency of intestinal metaplasia of gastric antrum and anguli,the New Sydney system pathological scores of gastric antrum in high reflux group were significantly higher than that in low reflux group(P0.05).Conclusions Bile reflux is possibly the main cause to mucosal lesions of gastric antrum in primary pathological duodenogastric reflux.Bile reflux may inhibit Hp to locate in gastric antrum.Hp infection and bile reflux can contribute to mucosal lesions of gastric body cooperatively.