Predisposing factors and histopathological changes in duodenogastric reflux: a retrospective case-control study

Duodenogastric reflux (DGR), defined as the retrograde flow of duodenal contents into the stomach, has an incompletely understood pathophysiology. This study aimed to evaluate the relationship between DGR and clinical, endoscopic, histopathological, and laboratory parameters in dyspeptic patients, and to assess its association with Helicobacter pylori (H. pylori) infection, intestinal metaplasia, and potential risk factors.

This retrospective case-control study included 524 patients who underwent upper gastrointestinal endoscopy between January 2017 and December 2022. A total of 287 patients with endoscopic signs of DGR such as bile pooling, mucosal edema, or hyperemia were classified as the DGR group, while 237 patients without these findings served as controls. Clinical, biochemical, endoscopic, and histopathological data were compared, and risk factors were analyzed using multivariate logistic regression.

Chemical gastropathy was significantly more frequent in the DGR group (p < 0.001). There were no significant differences regarding intestinal metaplasia or H. pylori positivity (p > 0.05). The DGR group showed higher total bilirubin and lower albumin levels (p < 0.05). Cholecystectomy and cholelithiasis were identified as independent strong risk factors (p < 0.001), while age contributed modestly; gender and H. pylori infection showed no significant association.

DGR is a multifactorial condition associated with gastric mucosal injury and systemic biomarker changes. A history of cholecystectomy or gallstones markedly increases DGR risk. Its independent role in intestinal metaplasia remains uncertain, warranting further prospective research.