Ewha Med J.  2013 Mar;36(1):18-25. 10.12771/emj.2013.36.1.18.

Clinicopathologic Charateristics and Gallbladder Dysfunction in Patients with Endoscopic Bile Reflux

• Na YJ
• Chung KW
• Yi SY

• KMID: 2284011
• DOI: http://doi.org/10.12771/emj.2013.36.1.18

Abstract

OBJECTIVES
To investigate clinicopathologic findings and gallbladder (GB) function in patients with endoscopic bile reflux at outpatients clinic.
METHODS
We classified endoscopic bile reflux into two groups by bile reflux index (BRI). Those who scored above 14 were the BRI (+) group, and those below 14 were the BRI (-) group. We analyzed clinical characteristics, endoscopic findings including Helicobacter pylori, GB function by DISIDA scan, and electron microscope (EM) findings of endoscopic bile reflux. And we compared clinicopathologic characteristics and GB function between two groups.
RESULTS
Endoscopic bile reflux identified in 9.7% of all cases with gastrointestinal symptoms. There are cholecystectomy in 6.7%, gastrectomy in 2.7%, and GB dysfunction in 20.0%. They had prominent gastrointestinal symptoms with variable endoscopic findings. Foveolar hyperplasia is the most common pathologic finding and H. pylori colonization of the stomach was inhibited in cases of bile reflux gastritis. Bile reflux also had distinguishable ultra-structural changes identifiable by EM. BRI (+) group had more old age, GB dysfunction than BRI (-) group. Clinical symptoms and endoscopic findings did not differ between the two groups of endoscopic bile reflux.
CONCLUSION
Endoscopic bile reflux was common findings with young adults (30's) at outpatients clinic. Foveolar hyperplasia is common pathologic finding. GB dysfunction were identified as significant risk factors for BRI (+) group.

Keyword

Bile reflux; DISIDA; Electron microscopy; Gastritis; Helicobacter pylori

MeSH Terms

Bile
Bile Reflux
Cholecystectomy
Colon
Electrons
Gallbladder
Gastrectomy
Gastritis
Helicobacter pylori
Humans
Hyperplasia
Microscopy, Electron
Outpatients
Risk Factors
Stomach
Young Adult

Figure

• 

  Fig. 1 Age and sex distribution of patients with endoscopic bile reflux. Peak incidence of age is thirties (30's). In 70's, there is an increase in the ratio of males to females.

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  Fig. 2 The presence of Helicobacter pylori (HP) in patients with endoscopic bile reflux and the Korean population.

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  Fig. 3 Ultrastructure of gastric villi. (A) Ultrastructure of normal gastric mucosa. Number and height of villi were normal. (B) Ultrastructure of endoscopic bile reflux gastric mucosa (BRI<14). Numbers and height of villi are decreased. Also mucus droplets of villi are decreased. (C) Ultrastructure of endoscopic bile reflux of gastric mucosa (BRI>14). Numbers and height of villi are decreased. Also mucus droplets of villi are decreased (×3,000).

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  Fig. 4 Ultrastructure of gastric mucus layer and intracellular spaces. (A) Ultrastructure of normal gastric mucosa. There are no destruction of mucus layers and no dilated intercellular spaces. (B) Ultrastructure of endoscopic bile reflux gastric mucosa (BRI<14). There is slightly destruction of mucus layers. There are no dilated intercellular spaces. (C) Ultrastructure of endoscopic bile reflux gastric mucosa (BRI>14). There is slightly destruction of mucus layers and there are dilated intercellular spaces (×5,000).

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