What Is Bile Reflux?

Bile reflux gastritis, also known as alkaline reflux gastritis, refers to duodenal contents containing bile, pancreatic juice and other fluids flowing into the stomach due to pyloric sphincter dysfunction or gastric pyloric surgery, etc., causing gastric mucosa It produces inflammation, erosion and bleeding, weakens the barrier function of the gastric mucosa, causes an increase in H + diffusion, and causes chronic lesions of the gastric mucosa.

Basic Information

nickname: Alkaline reflux gastritis
English name: bile reflux gastritis
Visiting department: Gastroenterology

Common causes: Helicobacter pylori infection, stomach acid, bile reflux, etc.
Common symptoms: Abdomen fullness and discomfort, heartburn, belching, acid reflux, vomiting, etc.
Contagious: no

Causes of bile reflux gastritis

The cause of bile reflux gastritis is mainly gastrectomy, gastrojejunostomy, and pyloric dysfunction and chronic biliary disease, bacterial (especially Helicobacter pylori) infection, gastric acid, bile and other damage to the gastric mucosa causing inflammation and increase The release of gastrin affects the gastroduodenal motility, leading to a disorder of the coordinated movement of the stomach-pylorus-duodenum, causing an increase in duodenal reverse peristalsis, weakening of the pyloric closing function, and delayed gastric emptying, making the duodenum The contents flow back into the stomach in excess.

Any disturbance of gastrointestinal motility, such as abnormal levels of gastrointestinal neuropeptides and hormones, can cause gastrointestinal movement disorders, anatomical abnormalities, such as primary pyloric sphincter dysfunction, can prolong pyloric opening time, relax pylorus, or continue to open State, pathological duodenogastric reflux can occur.

Clinical manifestations of bile reflux gastritis

Bloating

It is manifested as abdominal fullness and discomfort, continuous burning sensation in the middle and upper abdomen, and may also be manifested as posterior sternum pain, which can be aggravated after meals. It may be aggravated without taking alkaline drugs.

Heartburn

The stomach has a burning sensation, and even some patients have a burning esophagus, often accompanied by belching, acid reflux, nausea, vomiting, bowel movements, poor bowel movements, loss of appetite, and weight loss.

3. Gastric bleeding

Patients with severe bile reflux gastritis may also experience gastric bleeding. Some patients have black stools (tar-like stools), and some have vomiting blood.

4. Vomiting

Due to gastric emptying disorders, vomiting usually occurs at night or in the middle of the night, and some patients have blood in the vomit.

Bile reflux gastritis examination

Gastroscopy

Endoscopic reflux can be observed: a large amount of pale yellow to yellow-green retention fluid in the gastric cavity, or more bile-containing mucus on the stomach wall, or bile-containing duodenal fluid is seen as yellow foam or water flow Reverse flow into the stomach from the pyloric opening, the pyloric opening is loose or in an open and fixed state; gastritis manifestations: diffuse red changes in the gastric mucosa, mucosal folds and edema, or erosions and ulcers.

2. Determination of gastric aspirate

By inserting a gastric tube from the patient's nasal cavity to the gastric cavity, and then aspirating fasting and postprandial gastric juice, measuring the bile acid content, such as fasting basic gastric acid secretion h, bile acid> 30 g / ml, can confirm the diagnosis of bile reflux gastritis.

3.Isotopic determination

Intravenous injection of 2mCi of Tc-butimine diacetate, observation of the liver, gallbladder and gastric area, determine the gastrointestinal reflux index. By measuring the content of isotope in the stomach, we can understand the degree of gastrointestinal reflux.

Diagnosis of bile reflux gastritis

The diagnosis and differentiation of bile reflux gastritis mainly rely on gastroscopy and gastric aspirate measurement. Isotope measurement can understand the degree of reflux.

Complications of bile reflux gastritis

The disease can be complicated by esophageal strictures, bleeding, and ulcers. The reflux of gastric juice can invade the throat, vocal cords, and trachea to chronic pharyngitis, chronic vocal cord inflammation, and bronchitis, which is clinically known as Delahunty syndrome. Gastric reflux and aspiration into the respiratory tract can cause aspiration pneumonia. Long-term bile reflux can cause esophagitis, gastric mucosal erosion, hyperplasia, active inflammation, gastric ulcers, and even the occurrence of gastric cancer.

Bile Reflux Gastritis Treatment

Drug treatment

(1) Gastric motility drugs: can increase gastrointestinal motility, inhibit bile from flowing back into the stomach, and promote the emptying of reflux. Commonly used are: domperidone (morpholin), mosapride (xinluona) and so on.

(2) There are many types of gastric mucosal protective agents. Their main functions include the ability to form a protective film by combining with mucin of gastric mucosa to reduce the stimulation of reflux bile and gastric acid on gastric mucosa and strengthen the role of the gastrointestinal mucosal barrier. The regeneration of gastric mucosa promotes the secretion of mucus from the gastric mucosa, thereby protecting the gastric mucosa and promoting inflammation and healing.

(3) Combining bile salts: Daxi (aluminum magnesium carbonate), by combining with bile acid and lysophosphatidylcholine, then reduces the damage of bile salts to gastric mucosa, and has obvious effects on bile reflux gastritis. It is mainly used in clinical practice. Anion exchange resin (cholestyramine) releases chloride ions after oral administration and combines with bile acid to form an insoluble and non-absorbable complex, which accelerates the excretion of bile salts and feces and reduces gastric mucosal damage.

(4) Stomach acid inhibitors: Stomach acid and bile have a superimposed effect, which has a strong effect on the gastric mucosa. Acid inhibitors are also effective for bile reflux. H2 receptor blockers (H2RA): cimetidine, ranitidine, famotidine; proton pump inhibitors (PPI): omeprazole, lansoprazole, rabeprazole, Torrazole and esomeprazole have far better acid suppression than H2 receptor blockers.

(5) eradication of Helicobacter pylori infection: Bile reflux gastritis can coexist with Helicobacter pylori infection. In the routine application of acid inhibitors, gastric mucosal protective agents and gastric motility drugs, the eradication of Helicobacter pylori should be considered first. Not only is conducive to healing of the lesion, but also reduces the chance of inducing canceration.

2. Surgical treatment

It is mainly applicable to those who have severe symptomatic medical treatment. Roux-en-Y surgery or biliary shunt surgery is commonly used.

3. Diet

Diet should be light, do not eat greasy food, so as not to stimulate increased bile secretion, increase reflux and illness. Should chew slowly and avoid overeating. Avoid sips of tea, spirits, espresso, and spicy, cold, hot, and rough foods.

4. Remove certain factors that aggravate the condition

Including smoking cessation, avoiding stress, maintaining a comfortable mood, not taking or cautiously taking drugs that irritate the gastric mucosa.

Bile reflux gastritis prevention

Pay attention to adjusting your diet and lifestyle. Through the healthy diet and the development of good living habits, the occurrence of bile reflux gastritis can be prevented and controlled to the greatest extent.