Abstract
Gastric biopsy specimens from patients who have undergone gastric surgery frequently exhibit foveolar hyperplasia, oedema, vasodilatation and congestion, and a paucity of inflammatory cells as consequences of entero-gastric reflux. Similar, albeit generally milder, changes were found in 47 of 316 (15%) non-surgical patients undergoing endoscopy for dyspeptic symptoms. To relate these changes to bile reflux or other potential gastric irritants the total bile acid concentration was measured in samples of fasting gastric juice, and the use of a symptom questionnaire ascertained the patients' cigarette consumption, use of non-steroidal anti-inflammatory drugs (NSAIDs), and alcohol intake. When patients with reflux gastritis were compared with normal controls (n = 91), significant increases in associated peptic ulceration and NSAID use were found in the group with reflux, but no increases in bile acid concentrations. Indeed, only one patient had evidence of duodenogastric reflux. It is concluded that most cases of "reflux gastritis" in the intact stomach are not due to reflux of bile. Our findings indicate an important pathogenic role for long term NSAID use, in what might be usefully termed type C or "chemical" gastritis.
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- Dewar E. P., King R. F., Johnston D. Bile acid and lysolecithin concentrations in the stomach of patients with gastric ulcer: before operation and after treatment by highly selective vagotomy, Billroth I partial gastrectomy and truncal vagotomy and pyloroplasty. Br J Surg. 1983 Jul;70(7):401–405. doi: 10.1002/bjs.1800700704. [DOI] [PubMed] [Google Scholar]
- Dixon M. F., O'Connor H. J., Axon A. T., King R. F., Johnston D. Reflux gastritis: distinct histopathological entity? J Clin Pathol. 1986 May;39(5):524–530. doi: 10.1136/jcp.39.5.524. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Doube A., Morris A. Nonsteroidal anti-inflammatory drug-induced dyspepsia--is Campylobacter pyloridis implicated? Br J Rheumatol. 1988 Apr;27(2):110–112. doi: 10.1093/rheumatology/27.2.110. [DOI] [PubMed] [Google Scholar]
- Graham D. Y., Smith J. L., Spjut H. J., Torres E. Gastric adaptation. Studies in humans during continuous aspirin administration. Gastroenterology. 1988 Aug;95(2):327–333. [PubMed] [Google Scholar]
- Houghton P. W., Mortensen N. J., Thomas W. E., Cooper M. J., Morgan A. P., Burton P. Intragastric bile acids and histological changes in gastric mucosa. Br J Surg. 1986 May;73(5):354–356. doi: 10.1002/bjs.1800730509. [DOI] [PubMed] [Google Scholar]
- Laine L., Weinstein W. M. Histology of alcoholic hemorrhagic "gastritis": a prospective evaluation. Gastroenterology. 1988 Jun;94(6):1254–1262. doi: 10.1016/0016-5085(88)90661-0. [DOI] [PubMed] [Google Scholar]
- McIntyre R. L., Irani M. S., Piris J. Histological study of the effects of three anti-inflammatory preparations on the gastric mucosa. J Clin Pathol. 1981 Aug;34(8):836–842. doi: 10.1136/jcp.34.8.836. [DOI] [PMC free article] [PubMed] [Google Scholar]
- O'Connor H. J., Wyatt J. I., Dixon M. F., Axon A. T. Campylobacter like organisms and reflux gastritis. J Clin Pathol. 1986 May;39(5):531–534. doi: 10.1136/jcp.39.5.531. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Oates P. J., Hakkinen J. P. Studies on the mechanism of ethanol-induced gastric damage in rats. Gastroenterology. 1988 Jan;94(1):10–21. doi: 10.1016/0016-5085(88)90604-x. [DOI] [PubMed] [Google Scholar]
- Parl F. F., Lev R., Thomas E., Pitchumoni C. S. Histologic and morphometric study of chronic gastritis in alcoholic patients. Hum Pathol. 1979 Jan;10(1):45–56. doi: 10.1016/s0046-8177(79)80071-4. [DOI] [PubMed] [Google Scholar]
- Rainsford K. D. An analysis of the gastro-intestinal side-effects of non-steroidal anti-inflammatory drugs, with particular reference to comparative studies in man and laboratory species. Rheumatol Int. 1982;2(1):1–10. doi: 10.1007/BF00541263. [DOI] [PubMed] [Google Scholar]
- Rees W., Rhodes J. Bile reflux in gastro-oesophageal disease. Clin Gastroenterol. 1977 Jan;6(1):179–200. [PubMed] [Google Scholar]
- Rhodes J., Barnardo D. E., Phillips S. F., Rovelstad R. A., Hofmann A. F. Increased reflux of bile into the stomach in patients with gastric ulcer. Gastroenterology. 1969 Sep;57(3):241–252. [PubMed] [Google Scholar]
- Upadhyay R., Howatson A., McKinlay A., Danesh B. J., Sturrock R. D., Russell R. I. Campylobacter pylori associated gastritis in patients with rheumatoid arthritis taking nonsteroidal anti-inflammatory drugs. Br J Rheumatol. 1988 Apr;27(2):113–116. doi: 10.1093/rheumatology/27.2.113. [DOI] [PubMed] [Google Scholar]
- WILLIAMS A. W. Effects of alcohol on gastric mucosa. Br Med J. 1956 Feb 4;1(4961):256–259. doi: 10.1136/bmj.1.4961.256. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Wyatt J. I., Dixon M. F. Chronic gastritis--a pathogenetic approach. J Pathol. 1988 Feb;154(2):113–124. doi: 10.1002/path.1711540203. [DOI] [PubMed] [Google Scholar]