Comparison of clinical, endoscopic, and histological features of patients diagnosed with alkaline reflux gastritis before and after ursodeoxycholic acid treatment

Yıl 2017, , 53 - 56, 23.11.2017

Halil Rakıcı

https://doi.org/10.17940/endoskopi.339843

Öz

Abstract: Bacground and Aims. Alkaline reflux gastritis is
characterized by non-acidic flow from the duodenum to the stomach. It is seen
very commonly among operated patients. It can also be seen among non-operated
patients, due to a defect in duodenogastric antireflux mechanisms. Various medications
are used for its treatment. We aimed to analyze the clinical, endoscopic, and
histological effects of ursodeoxycholic acid in non-operated patients in this
study. Material and Methods. A total of 72 patients who were diagnosed with
alkaline reflux gastritis as a result of endoscopic imagining were treated with
ursodeoxycholic acid. Clinical, endoscopic, and histological features were analyzed
after 2 months of treatment. A total of 72 patients were analyzed clinically, and
61 patients who had control endoscopy were analyzed endoscopically and
histologically. Results. Of the
total, 38 patients were female and 34 were male. The youngest and oldest patients
were 19 and 81 years of age, respectively. The average age was 50 years. After treatment,
54 patients out of 72 reported benefits. Sixteen patients out of 61 who had
control endoscopy were diagnosed endoscopically with alkaline reflux gastritis.
Normal mucosa was observed instead of chronic gastritis and inflammation in 6
out of 61 patients who had control histological examination. Conclusion. In all, 75% of the patients who were
treated with ursodeoxycholic acid recovered clinically. Altogether, 73.7% of patients
recovered endoscopically. Only 9.9% of patients recovered histologically. In
conclusion, ursodeoxycholic acid treatment is effective clinically and
endoscopically but is ineffective histologically.

Anahtar Kelimeler

alkaline reflux, gastritis, ursodeoxycholic acid

Alkalen reflü gastrit tanısı ile ursodeoksikolik asit tedavisi almış hastaların tedavi öncesi ve sonrası klinik, endoskopik ve histolojik bulgularının değerlendirilmesi

Öz

Giriş ve Amaç: Alkalen reflü gastrit asidik olmayan
safranın mide içine reflüsüne verilen isimdir. Opere midede sık görülmekle
birlikte cerrahi girişim geçirmeyen hastalarda da duodenogastrik antifeflü
mekanizmalardaki bozukluk sonucunda ortaya çıkmaktadır. Medikal tedavisinde
çeşitli ilaçlar kullanılmaktadır. Biz bu çalışmada cerrahi girişim geçirmemiş
hastalarda ursodeoksikolik asitin klinik, endoskopik ve histolojik etkilerini
incelemeyi amaçladık. Gereç ve Yöntem: Endoskopik inceleme sonucu alkalen reflü gastrit saptanan 72 hastaya
ursodeoksikolik asit tedavisi verildi. İki aylık tedavi sonunda klinik,
endoskopik ve histolojik bulgular değerlendirildi. Klinik değerlendirme 72
hastada, endoskopik ve histolojik değerlendirme ise kontrol endoskopi yaptıran
61 hasta üzerinden yapıldı. Bulgular: Hastaların 38’i (%52.7) kadın, 34’ü (%47.3) erkekti. En küçük yaş 19, en
büyük yaş 81 olup, ortalama yaş 50 idi. Tedavi sonrası 72 hastanın 54’ü (%75)
tedaviden fayda gördüğünü bildirdi. Kontrol endoskopi yapılan 61 hastanın
45’inde (%73.7) endoskopik tanı alkalen reflü gastrit olarak bildirilmedi.
Kontrol histolojik inceleme yapılan 61 hastanın 6’sında (%9.9) kronik gastrit
ve inflamasyon yerine normal mukoza saptandı. Sonuç: Ursodeoksikolik asit tedavisi verilen hastaların %75’inin
klinik olarak tedaviden fayda gördüğü saptandı. Endoskopik olarak tedavi
sonrası hastaların %73.7’sinde alkalen reflü gastrit saptanmadı. Histolojik
olarak hastaların ancak %9.9’unda histolojik bulguların düzeldiği görüldü. Bu
bulgularla alkali reflü gastrit tedaviside ursodeoksikolik asitin klinik ve
endoskopik bulguların düzelmesinde etkili, histolojik bulguları düzeltmede ise
etkisiz olduğunu söylemek mümkündür.

Anahtar Kelimeler

Alkalen reflü, gastrit, ursodeoksikolik asit

Kaynakça

• 1-Feldman M, Edward LL, “Gastritis‘‘ in Sleisenger and Fordtran’s Gastrointestinal and Liver Disease. Pathophysiology/Diagnosis/Management, M. Feldman, S. F. Lawrence, andJ. B. Lawrence, Eds., pp.880-881, Saunders, Philadelphia, Pa,USA, 10th edition, 2015. 2-Pamela J Jensen, Mark Feldman. Acute hemorrhagic erosive gastropathy and chronic chemical gastropathy.Literature review current through: Apr 2017. | This topic last updated: Dec 17, 2015. UpToDate 3-Niemelä S. Duodenogastric reflux in patients with upper abdominal complaints or gastric ulcer with particular reference to reflux-associated gastritis. Scand J Gastroenterol Suppl. 1985;115:1. 4-Dixon MF, O'Connor HJ, Axon AT,et al. Reflux gastritis: distinct histopathological entity? J Clin Pathol. 1986;39(5):524. 5-Weinstein WM, Buch KL, Elashoff J,et al. The histology of the stomach in symptomatic patients after gastric surgery: a model to assess selective patterns of gastric mucosal injury. Scand J Gastroenterol Suppl. 1985;109:77. 6-Nakamura M, Haruma K, Kamada T, et al. Duodenogastric reflux is associated with antral metaplastic gastritis. Gastrointest Endosc. 2001;53(1):53. 7-Orchard R, Reynolds K, Fox B,et al. Effect of lysolecithin on gastric mucosal structure and potential difference. Gut. 1977;18(6):457. 8-Eastwood GL. Effect of pH on bile salt injury to mouse gastric mucosa. A light- and electron-microscopic study. Gastroenterology. 1975;68(6):1456. 9-Karttunen T, Niemelä S. Campylobacter pylori and duodenogastric reflux in peptic ulcer disease and gastritis. Lancet. 1988;1(8577):118. 10-Bondurant FJ, Maull KI, Nelson HS Jr,et al. Bile reflux gastritis. South Med J. 1987;80(2):161. 11-Stein HJ, Smyrk TC, DeMeester TR,et al. Clinical value of endoscopy and histology in the diagnosis of duodenogastric reflux disease. Surgery. 1992;112(4):796. 12-NiemeläS, Karttunen T, Heikkilä J,et al. Characteristics of reflux gastritis. Scand J Gastroenterol. 1987;22(3):349. 13- Chen H, Li X, Ge Z, et al. Rabeprazole combined withhydrotalcite is effective for patients with bile reflux gastritis after cholecystectomy. Can J Gastroenterol 2010;24:197-201. 14-Davidson ED, Hersh T. The surgical treatment of bile reflux gastritis: a study of 59 patients. Ann Surg. 1980;192(2):175. 15-Stefaniwsky AB, Tint GS, Speck J,et al. Ursodeoxycholic acid treatment of bile reflux gastritis. Gastroenterology. 1985;89(5):1000. 16-Buch KL, Weinstein WM, Hill TA, et al. Sucralfate therapy in patients with symptoms of alkaline reflux gastritis. A randomized, double-blind study. Am J Med. 1985;79(2C):49. 17-Nicolai JJ, van de Stadt J, Tytgat GN. Double-blind crossover trial of prostaglandin E2 in postgastrectomy reflux gastritis. Dig Dis Sci. 1986;31(12):1281. 18-Nicolai JJ, Speelman P, Tytgat GN,et al. Comparison of the combination of cholestyramine/alginates with placebo in the treatment of postgastrectomy biliary reflux gastritis. Eur J Clin Pharmacol. 1981;21(3):189.