The Influence of Bile Reflux, Gastric Acid and Helicobacter pylori Infection on Gastric Mucosal Injury: Severity and Localization

Background: It is well known that bile reflux, gastric acid and Helicobacter pylori (H. pylori) in-fection cause gastric mucosal injury. However, the combinative roles of these factors were obscure. Aims: To investigate the damage of bile reflux, gastric acid and H. pylori infection to gastric mucosa on severity and localization. Methods: A total of consecutive 37 patients who were suspected with duo-deno-gastric reflux, performed the 24-hour bile and gastric pH monitoring tests simultaneously. Active inflammation, atrophy, intestinal metaplasia and hyperplasia in the gastric mucosa of the corpus and antrum were investigated and scored. A stepwise Logistic regression analysis between gastric patho-logical changes and the time percentage of bilirubin absorption value 0.14, the time percentage of pH 4, and the presence of H. pylori was carried out. Results: The time percentage of bilirubin absorp-tion value0.14 and pH4 were 34.49% ?2.69% and 78.68% ?.91%, respectively. The H. pylori infec-tion rate was 29.73%. Bile reflux was present in the Logistic regression models when there was intes-tinal metaplasia in the gastric mucosa of the corpus and antrum and active inflammation in the gastric mucosa of the corpus. H. pylori was present when there was active inflammation. Conclusions: Bile reflux causes intestinal metaplasia, and H. pylori is the most important etiological factor for corpus gastritis in the presence of bile reflux.