Bile Reflux Gastritis: Insights into Pathogenesis, Relevant Factors, Carcinomatous Risk, Diagnosis, and Management

Abstract

Bile reflux gastritis (BRG), a kind of gastrointestinal disorder in clinical practice, is characterized by regurgitation and inflammation. However, lack of guidelines leads to simple cognition and even ignorance of this disease for clinicians. Primarily, making the pathogenesis of BRG clear contributes to a correct and general understanding of this disease for physicians. Next, although recently there has been an increasing awareness among researchers in terms of the relevant factors for BRG, further studies involving large samples are still required to certify the relationship between them explicitly. Besides, researches have established that BRG is closely associated with the development of precancerous lesions and gastric cancer. Till now, there is still no golden standard for diagnosis of BRG. Nevertheless, advances in techniques, especially extensive applications of endoscopy and chemical analysis of reflux contents, have improved our ability to identify the occurrence of this disease as well as distinguishing physiological reflux from pathological reflux. Finally, it is fortunate for patients that more and more importance has been attached to the treatment of BRG. From lifestyle modification to drug therapy to surgery, all of them with the view of realizing symptomatic relief are employed for patients with BRG. In this review, we briefly evaluate this disorder based on the best available evidence, offering an overview of its complicated pathogenesis, diverse relevant factors, potential carcinomatous risk, modern diagnostic investigations, and effective therapeutic plans.

Persistent Post-endoscopic Retrograde Cholangiopancreatography Hiccups: An Unusual Presentation of Bile Reflux

“…Alkaline bile neutralizes the acidity of the stomach and turns it into a breeding ground for bacteria. Furthermore, bile acids and lysolecithin dissolve the fatty protective barrier of the gastric mucosa and expose it to hydrochloric acid, leading to gastritis [ 2 , 4 - 5 ]. It typically manifests as abdominal pain, dyspepsia, nausea, bilious vomiting, or heartburn [ 1 , 4 ].…”

Unusual Case of Biliary Peritonitis in a Dog Secondary to a Gastric Perforation

“…Moreover, duodenal reflux liquids contain gut microbiome that can result in the imbalance of microbial flora in the stomach [ 32 ]. Moreover, the rise in the pH value due to alkaline bile creates a favorable environment for bacterial multiplication, further aggravating gastric inflammation [ 33 ]. In this patient, the probability of developing a gastric perforation could be facilitated by the administration of nonsteroidal anti-inflammatory drugs (NSAIDs), as reported in the dog’s anamnesis.…”

Gastric precancerous lesions:occurrence, development factors, and treatment

“…The concentration and duration of bile exposure are positively correlated with the incidence of GC and may lead to the recurrence of gastric stump cancer ( 73 ). A clinical study from China also showed that the independent risk factors of GC lesions included bile reflux grade, patient age, diet habits, and GC family history ( 73 ).…”

“…The concentration and duration of bile exposure are positively correlated with the incidence of GC and may lead to the recurrence of gastric stump cancer ( 73 ). A clinical study from China also showed that the independent risk factors of GC lesions included bile reflux grade, patient age, diet habits, and GC family history ( 73 ). Currently, the oncogenic mechanism of bile reflux is not fully understood, but it may be connected to the increased formation of reactive oxygen species (ROS) and reactive nitrogen species (RNS) induced by bile acid exposure that result in DNA damage and mutation of the oncogene p53 ( 74 ).…”