Relationship between Bile Reflux and the Severity of Gastric Mucosal Damage in Patients with Dyspepsia
), I Ketut Mariadi(2), I Nyoman Triyanayasa(3), Dwijo Anargha Sindhughosa(4), Toshio Kuwai(5),
(1) Division of Allergy and Immunology, Department of Internal Medicine, Udayana University / Prof. Dr. I.G.N.G. Ngoerah Hospital, Denpasar, Bali, Indonesia
(2) Gastroentero-Hepatology Division, Department of Internal Medicine, Faculty of Medicine Udayana University, Bali Indonesia
(3) Department of Internal Medicine, Udayana University / Prof. Dr. I.G.N.G. Ngoerah Hospital, Denpasar, Bali, Indonesia
(4) Division of Gastroenterology-Hepatology, Department of Internal Medicine, Udayana University / Prof. Dr. I.G.N.G. Ngoerah Hospital, Denpasar, Bali, Indonesia
(5) Gastrointestinal Endoscopy and Medicine, Hiroshima University Hospital, Hiroshima, Japan
Corresponding Author
Abstract
Background: Dyspepsia is a complaint of pain in the epigastrium that lasts for at least 1 month and is closely related to upper gastrointestinal complaints such as nausea, vomiting, and a feeling of early fullness. One of the risk factors for dyspepsia is bile acid reflux. The most common endoscopic findings in patients with bile acid reflux include mucosal erythema, the presence of bile acid on the mucosa, erosion, hyperugosity, and gastric mucosal atrophy.
Methods: This study was a cross-sectional study conducted on 99 dyspeptic patients who underwent endoscopy at Prof. Dr. I.G.N.G. Ngoerah Denpasar Hospital. Bile acid examination was performed using the enzymatic calorimetric method, and mucosal damage assessment was based on the Lanza score evaluated by 2 observers. The degree of mucosal damage was classified as mild (score 0-2) and severe (score 3-5).
Results: The age range of the 99 subjects was 19-83 years, with 58 (58.6%) males and 41 (41.4%) females. H. pylori antibodies were detected in 21% of the subjects, and 48% had a pH below 2.77; 48% had a history of NSAID consumption. The mean value of bile acid levels in gastric fluid was 156.07 μmol/L, with a median of 170.09 μmol/L (≥170.09 μmol/L classified as high, <170.09 μmol/L classified as low). During endoscopic observation, mild mucosal damage was found in 61%, and severe damage was found in 39% (kappa 1, P<0.001). According to the Chi-square test, there was a statistically significant relationship between gastric fluid bile acid levels and mucosal damage (P<0.05).
Conclusion: This study concludes that there is a relationship between the level of bile acid in gastric fluid and the degree of mucosal damage.
Keywords
References
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DOI: 10.24871/2522024295
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