Histological features of the gastric mucosa in children with primary bile reflux gastritis
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WORLD JOURNAL OF SURGICAL ONCOLOGY
RESEARCH
Open Access
Histological features of the gastric mucosa in children with primary bile reflux gastritis Yanyi Zhang, Xi Yang, Weizhong Gu, Xiaoli Shu, Ting Zhang and Mizu Jiang*
Abstract Background: Bile reflux is one of the primary factors involved in the pathogenesis of gastric mucosal lesions in patients with chronic gastritis; however, little is known about the exact histological features of bile reflux and its contributions to gastric mucosal lesions in this disease, especially in children with primary bile reflux gastritis (BRG). The aim of this study was to investigate the classic histological changes of the gastric mucosa in children with primary BRG. Methods: The Bilitec 2000 was used for 24 h monitoring of gastric bile in 59 children with upper gastrointestinal symptoms. The histological characteristics of the gastric mucosa were examined and scored. Results: Thirteen of the 59 patients had a helicobacter pylori infection and were excluded; therefore, 46 cases were included in this study. The positive rate of pathological duodenogastric reflux was significantly higher in patients with foveolar hyperplasia than those without foveolar hyperplasia; however, the rate was significantly lower in patients with vascular congestion than those without vascular congestion. The longest reflux time and the total percentage time of bile reflux were significantly lower in patients with vascular congestion than those without vascular congestion. A total of 9 types of histological changes were analyzed using a binary logistic regression. Foveolar hyperplasia and vascular congestion in the superficial layer became significant variables in the last step of the stepwise regression. Conclusions: Foveolar hyperplasia was associated with the severity of bile reflux, suggesting that it is a histological feature of primary BRG in children, while vascular congestion may be a protective factor. Keywords: Bile reflux, Reflux gastritis, Bilirubin monitoring, Gastric mucosa, Children
Background In addition to gastric acid and Helicobacter pylori (HP), bile reflux is one of the primary factors involved in the pathophysiological processes leading to gastric mucosal lesions in patients with chronic gastritis; however, little is known about the exact histological features of bile reflux and its contributions to gastric mucosal lesions in this disease [1,2]. When duodenal contents reflux into the stomach for a short period during a physiological event, it causes few symptoms. However, duodenogastric reflux (DGR) becomes pathological when it is excessive or lasts for an extended period of time. Bile reflux gastritis (BRG) is due to an excessive reflux of bile, pancreatic and * Correspondence: [email protected] Department of Gastroenterology, Children’s Hospital, Zhejiang University School of Medicine; Key Laboratory of Reproductive Genetics (Zhejiang University), Ministry of Education, Hangzhou 310003, P.R. China
intestinal secretions into the stomach. The increased bile reflux may cause increa
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