Reflux esophagitis and duodenogastric reflux

Area of Science:

• Gastroenterology
• Esophageal Pathophysiology
• Digestive Diseases

Background:

• Gastroesophageal reflux disease (GERD) encompasses various subtypes, including acid reflux (AR), bile reflux (BR), and mixed acid-biliary reflux (ABR).
• The distinct roles of acid and bile in the development of esophageal inflammation remain a subject of investigation.
• Understanding the etiological factors is crucial for accurate diagnosis and effective management of reflux esophagitis.

Purpose of the Study:

• To investigate and compare the endoscopic and histological characteristics of esophagitis in patients with different types of gastroesophageal reflux.
• To determine the prevalent factor contributing to the development of reflux esophagitis among acid, bile, and mixed reflux conditions.

Main Methods:

• Comparative study involving 65 asymptomatic controls, 14 patients with AR, 11 with BR, and 10 with ABR.
• Assessment of endoscopic findings indicative of esophagitis.
• Histological examination of esophageal biopsies to confirm esophagitis.
• Correlation analysis between endoscopic and histological diagnoses across different reflux groups.

Main Results:

• Esophagitis was observed endoscopically in 5 controls, 4 AR, 9 BR, and 7 ABR patients.
• Histological esophagitis was confirmed in 13 controls, 4 AR, 6 BR, and 5 ABR patients.
• Histological confirmation of endoscopic findings was significantly higher in BR (55%) and ABR (57%) groups compared to AR (33%) and controls (20%).

Conclusions:

• Bile reflux (BR) and acid-biliary reflux (ABR) are associated with a higher incidence and histological confirmation of esophagitis compared to acid reflux (AR) alone.
• Bile appears to be a significant, potentially prevalent factor in the pathogenesis of reflux esophagitis.
• These findings underscore the importance of considering bile's role in esophageal injury associated with reflux.