Gastric mucosal changes and Helicobacter pylori infection in patients with alkaline reflux gastritis

Abstract

Background and Aims: We tried to evaluate the frequency of Helicobacter pylori infection, foveolar hyperplasia, intestinal metaplasia, and gastric mucosal atrophy of the antrum in patients with alkaline reflux gastritis (bile reflux gastritis) by comparing these patients with a control group comprised of individuals without bile reflux gastritis. We also sought to interpret the results of the irritating effects of bile on the gastric mucosa. Materials and Methods: One hundred and fifteen of 220 patients presenting to our hospital and diagnosed as having alkaline reflux gastritis were included as the patient group, and 105 patients without bile reflux gastritis were included as the control group in our study. The presence of concentrating or precipitated bile in the gastric mucosa abundantly and observation of mucosal hyperemia and edema was considered to be alkaline reflux gastritis. Biopsies were taken from both patient and control groups, and the presence of intestinal metaplasia, foveolar hyperplasia, atrophy, and Helicobacter pylori in the tissue was investigated. Results: The rates of observation of intestinal metaplasia in the control group and the bile reflux gastritis group were found to be 9.5% and 10.1%; respectively. No statistically significant difference was determined between the groups regarding the rate of observation of intestinal metaplasia. The rate of observation of atrophy was found to be 7.6% and 10.1% in the control group and in the bile reflux gastritis group, respectively. No statistically significant difference was determined between the groups regarding the rate of observation of atrophy. In addition, histopathological investigation revealed foveolar hyperplasia was observed at a rate of 4.3% in patients with bile reflux gastritis, and 2.9% in the control group. The difference between these rates was not statistically significant. While the rate of observation of Helicobacter pylori in the control group was 80.0%, it was determined to be 60.6% in the bile reflux gastritis group. In addition, this rate in the bile reflux gastritis group was less than the group without bile reflux gastritis and was found to be statistically significant. Conclusion: The frequency of foveolar hyperplasia, intestinal metaplasia, and gastric mucosal atrophy of the antrum in patients with alkaline reflux gastritis was found to be similar to patients without bile reflux gastritis. The frequency of Helicobacter pylori infection in patients with bile reflux gastritis was determined to be significantly less than the control group. This condition might result from unsuitability of the alkaline medium for Helicobacter pylori caused by bile in the gastric mucosa.

 

Key words: Bile reflux gastritis, Helicobacter pylori, foveolar hyperplasia, intestinal metaplasia, antral gastric atrophyBackground and Aims: We tried to evaluate the frequency of Helicobacter pylori infection, foveolar hyperplasia, intestinal metaplasia, and gastric mucosal atrophy of the antrum in patients with alkaline reflux gastritis (bile reflux gastritis) by comparing these patients with a control group comprised of individuals without bile reflux gastritis. We also sought to interpret the results of the irritating effects of bile on the gastric mucosa. Materials and Methods: One hundred and fifteen of 220 patients presenting to our hospital and diagnosed as having alkaline reflux gastritis were included as the patient group, and 105 patients without bile reflux gastritis were included as the control group in our study. The presence of concentrating or precipitated bile in the gastric mucosa abundantly and observation of mucosal hyperemia and edema was considered to be alkaline reflux gastritis. Biopsies were taken from both patient and control groups, and the presence of intestinal metaplasia, foveolar hyperplasia, atrophy, and Helicobacter pylori in the tissue was investigated. Results: The rates of observation of intestinal metaplasia in the control group and the bile reflux gastritis group were found to be 9.5% and 10.1%; respectively. No statistically significant difference was determined between the groups regarding the rate of observation of intestinal metaplasia. The rate of observation of atrophy was found to be 7.6% and 10.1% in the control group and in the bile reflux gastritis group, respectively. No statistically significant difference was determined between the groups regarding the rate of observation of atrophy. In addition, histopathological investigation revealed foveolar hyperplasia was observed at a rate of 4.3% in patients with bile reflux gastritis, and 2.9% in the control group. The difference between these rates was not statistically significant. While the rate of observation of Helicobacter pylori in the control group was 80.0%, it was determined to be 60.6% in the bile reflux gastritis group. In addition, this rate in the bile reflux gastritis group was less than the group without bile reflux gastritis and was found to be statistically significant. Conclusion: The frequency of foveolar hyperplasia, intestinal metaplasia, and gastric mucosal atrophy of the antrum in patients with alkaline reflux gastritis was found to be similar to patients without bile reflux gastritis. The frequency of Helicobacter pylori infection in patients with bile reflux gastritis was determined to be significantly less than the control group. This condition might result from unsuitability of the alkaline medium for Helicobacter pylori caused by bile in the gastric mucosa.

Keywords

• Bile reflux gastritis,Helicobacter pylori,foveolar hyperplasia,intestinal metaplasia,antral gastric atrophy

Alkalen reflü gastritli hastalarda gastrik mukozal değişiklikler ve Helicobacter pylori enfeksiyonu

Öz

Giriş ve Amaç: Alkalen reflü gastriti (safra reflüsü gastriti) olan hastalarda, Helicobacter pylori enfeksiyonu, foveolar hiperplazi, intestinal metaplazi ve antral gastrik mukozal atrofinin sıklığını, safra gastriti olmayan kontrol grubu ile karşılaştırıp safranın gastrik mukozaya irritan etkisinin sonuçlarını değerlendirmeye çalıştık. Gereç ve Yöntem: Hastanemize başvuran 220 hastadan alkalen reflü gastrit tesbit edilen 115 tanesi vaka grubu, mide mukozasında safra reflüsü gastriti olmayan 105 hasta ise kontrol grubu olarak alındı. Mide mukozasında bol miktarda konsantre veya presipite safra varlığı ile mukozal hiperemi ve ödemin endoskopik olarak görülmesi alkalen reflü gastrit olarak kabul edildi. Her iki hasta grubunda da biyopsiler alındı ve dokuda intestinal metaplazi, foveolar hiperplazi, atrofi ve Helicobacter pylori varlığı araştırıldı. Bulgular: Kontrol grubu vakalarda intestinal metaplazi görülme oranı %9,5, safra gastriti grubunda intestinal metaplazi görülme oranı %10,1 bulunmuştur. Gruplar arasında intestinal metaplazi görülme oranları bakımından istatistiksel olarak anlamlı farklılık saptanmamıştır. Kontrol grubunda atrofi görülme oranı %7,6, safra gastriti grubunda atrofi görülme oranı %10,1 bulunmuştur. Gruplar arasında atrofi görülme oranları bakımından istatistiksel olarak anlamlı farklılık saptanmamıştır. Histopatolojik incelemede foveolar hiperplazi safra gastriti olan hastalarda %4,3 oranında görülürken, kontrol grubu vakalarda %2,9 oranında görülmekte olup aradaki fark istatistiksel olarak anlamlı değildir. Kontrol grubu vakalarda Helicobacter pylori görülme oranı %80,0 iken, safra gastriti grubunda %60,6 saptanmıştır. Safra gastriti grubunda Helicobacter pylori görülme oranının, safra gastriti olmayan gruptan düşük olması istatistiksel olarak anlamlı bulunmuştur. Sonuç: Alkalen reflü gastriti olan hastalarda, foveolar hiperplazi, intestinal metaplazi ve antral gastrik mukozal atrofi sıklığı safra gastriti olamayan hastalar ile benzer bulundu. Helicobacter pylori enfeksiyonu ise safra reflüsü gastrit olan hastalarda kontrol grubu hastalara göre belirgin olarak daha düşük bulundu. Bu durum; safranın gastrik mukozada oluşturduğu alkali ortamın Helicobacter pylori için uygun bir vasat olmamasından kaynaklanıyor olabilir.

Anahtar Kelimeler

• Safra reflüsü gastriti,Helicobacter pylori,foveolar hiperplazi,intestinal metaplazi,antral gastrik atrofi

Kaynakça

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