Intragastric Bile Acid Concentration and Intestinal Metaplasia in the Gastric Mucosa

Background/Aims: Enterogastric reflux of bile has been suspected as a risk factor of foregut cancer. Thus, we measured total intragastric bile acid to determine association between duodenogastric reflux and development of intestinal metaplasia known as premalignant gastric mucosal change. Methods: One hundred and three patients with a functional dyspepsia underwent endoscopy. Subsequently, samples of fasting gastric juice were taken from all patients for analysis of total bile acid. With the specimens from 5 sites of the antrum and body, the degree of intestinal metaplasia was evaluated by the update Sydney System and H. pylori infection was evaluated also by Warthin-Starry staining. Results: There was a significant correlation between the total bile acid level and the degree of intestinal metaplasia (r=0.278, p=0.005). Moreover, multiple linear regression test showed that the concentration of total bile acid was one of the independent risk factors for intestinal metaplasia regardless of age and H. pylori infection. Conclusions: These results suggest that intragastric bile acid may affect histologic premalignant changes of the gastric mucosa and thus, duodenogastric reflux may play a role in gastric carcinogenesis.