Is a bile reflux an additional cancerogenic factor in peptic ulcer, associated with Helicobacter pylori infection?

It's well known that Helicobacter pylori (H.p.) infection plays a leading role in gastric cancer in 70% of patients. A role of bile acids reflux in the stomach as a potentially cancerogenic factor is disputable. As the influence of both factors for malignancy, is still unknown, it was the aim of our investigations in peptic ulcer (PU) patients complicated with duodenogastric reflux (DGR).

79 PU patients (49 men, 27 women, aged 18 to 61, middle age--41.8 yrs) were observed; DGR was found in 40 of them. For all patients endoscopic examination with antral and fundal parts of the stomach mucosa biopsy were performed. The morphological picture was estimated by Dixon's scale.

The similar H.p. colonization level of the stomach mucosa independently of DGR presence was shown. A bile reflux co-exists with diminished acute and chronic inflammation activity and atrophy level. The quantity of the patients with complete intestinal metaplasia did not depend of DGR (32.5% vs. 33.3%), but in the patients with DGR it developed 16 years earlier (42.8 and 58.7 yrs, p < 0.05).

The combination of bile reflux and H.p. infection may cause progression to gastric cancer not by traditional stepwise: inflammation-atrophy-metaplasia.