PT  - JOURNAL ARTICLE
AU  - G M Sobala
AU  - H J O'Connor
AU  - E P Dewar
AU  - R F King
AU  - A T Axon
AU  - M F Dixon
TI  - Bile reflux and intestinal metaplasia in gastric mucosa.
AID  - 10.1136/jcp.46.3.235
DP  - 1993 Mar 01
TA  - Journal of Clinical Pathology
PG  - 235--240
VI  - 46
IP  - 3
4099  - http://jcp.bmj.com/content/46/3/235.short
4100  - http://jcp.bmj.com/content/46/3/235.full
SO  - J Clin Pathol1993 Mar 01; 46
AB  - AIM: To determine associations between enterogastric bile reflux and gastric mucosal pathology. METHOD: A retrospective study using fasting gastric juice bile acid measurements and antral or prestomal biopsy specimens from 350 patients, 66 of whom had previously undergone surgery that either bypassed or disrupted the pyloric sphincter. RESULTS: Bile reflux was positively associated with reactive gastritis and negatively with Helicobacter pylori density. After stratification for previous surgery, age, and H pylori status, the histological feature most strongly associated with bile reflux was intestinal metaplasia, including all its subtypes. The prevalence of intestinal metaplasia was greatest in patients with both H pylori infection and high bile acid concentrations. Bile reflux was also positively associated with the severity of glandular atrophy, chronic inflammation, lamina propria oedema and foveolar hyperplasia. CONCLUSIONS: Bile reflux is a cause of reactive gastritis. It modifies the features of H pylori associated chronic gastritis. The changes are not confined to patients who have had surgery to their stomachs. The positive associations with atrophy and intestinal metaplasia have implications for models of gastric carcinogenesis.