Relationship between duodenogastric reflux and chronic inflammation of gastric mucosa

Objective To investigate the relationship between duodenogastric reflux(DGR) and chronic inflammation of gastric mucosa in the patients with non ulcer dyspepsia. Methods Endoscopy, histologic examination and 24 hour intragastric bilirubin monitoring with Bilitec 2000 were performed in 56 patients with non ulcer dyspepsia. An absorbance value not less than 0.14 was accepted as the threshold value for the presence of bile reflux. The total fraction time of bile reflux was used as a marker to evaluate the severity of DGR. Results The patients were divided into two groups, the high reflux group (28 patients) and the low reflux group (28 patients), based on the severity of bile reflux. The frequency of Helicobacter pylori (H. pylori) infection was 46%(13/28)in the patients with high reflux and 50%(14/28) in the patients with low reflux( P 0.05). The frequency of topographic abnormalities of the antral mucosal detected by endoscopy in the high reflux group and in the low reflux group were 100% and 71%( P 0.05)for hyperemia, 18% and 11%( P 0.05) for hemorrhagic spots or macula, 39% and 21%( P 0.05)for erosion, 14% and 14%( P 0.05) for penetrating blood vessel, 46% and 18%( P 0.05)for bile stained mucosa, respectively. The score of chronic inflammation was higher in 27 patients with H. pylori infection than that in 29 patients without H. pylori infection (1.77±0.80 vs.1.07±0.75, P 0.05), and score of active inflammation in 27 patients with H. pylori infection was higher than that in 29 patients without H. pylori infection (1.48±0.85 vs. 0.86±0.64, P 0.05). There was a positive correlation between the total fraction time of bile reflux and antral intestinal metaplasia( r= 0.548, P0.05 ) in 27 patients with H. pylori infection. Significant association was found between the total fraction time of bile reflux and the antral chronic inflammation( r= 0.486, P 0.05 ), antral atrophy ( r= 0.476, P 0.05 ) and antral intestinal metaplasia( r=0.623,P 0.01 ) in 29 patients without H. pylori infection. Conclusion In the patients with non ulcer dyspepsia, excessive bile reflex was related to chronic lesion of gastric mucosa, regardless of H. pylori infection. No any characteristic phenotype in histology could be found.