Pathological features of the gastric mucosa in children with primary bile reflux gastritis

Objective Bile reflux is regarded as one of the important causes of chronic inflammation of the gastric mucosa, but the pathological features are unclear. The aim of this study was to investigate the pathological features of primary bile reflux gastritis (BRG) in children. Methods Bilitec 2000 was used for 24 h monitoring of gastric bile in 59 children with upper gastrointestinal symptoms. The 10 kinds of histological characteristics of the gastric mucosa, such as the degree of inflammation, lymphatic follicle hyperplasia, intestinal metaplasia, foveolar hyperplasia, and vascular congestion were examined and scored. Pathological duodenogastric reflux ( DGR) was defined as the total fraction time of bile reflux above 35.6%. Results Twenty-two out of 59 patients (37.3%) were diagnosed with pathological DGR. The positive rate of pathological DGR, the longest reflux time, and the total fraction time of bile reflux were significantly higher in patients with foveolar hyperplasia than those in patients without foveolar hyperplasia, but they were significantly lower in patients with vascular congestion than those in patients without vascular congestion. The 10 kinds of pathological alterations mentioned above were analyzed by binary logistic regression. Foveolar hyperplasia and vascular congestion in the superficial layer became the significant variables in the last step. Foveolar hyperplasia was a risk factor and vascular congestion was a protective factor in pediatric patients with bile reflux. Conclusions Foveolar hyperplasia was well correlated with the severity of bile reflux, which that it is suggested a specific pathological feature in children with primary BRG, while vascular congestion served as a protective factor.