Reflux gastritis syndrome. Role of upper gastrointestinal microflora

Bacteriologic samplings of the upper gastrointestinal tract bile acids profile of the intestinal contents were performed in eight patients with reflux gastritis syndrome and three asymptomatic patients who had had gastric surgery. All symptomatic patients showed colonization of the gastric and/or intestinal samples with strains of enteric Gram-negative bacteria and Pseudomonas. However, no single specific group or species was consistently associated with reflux gastritis syndrome. The concentration of total and conjugated bile acids was significantly greater in symptomatic patients. Presence of free bile acids was correlated with heavier bacterial colonization. To evaluate the effect of antibiotic therapy on bacterial flora and symptoms, patients were studied for three separate four-week evaluation periods. Following the first evaluation period, they were assigned to receive either doxycycline or placebo in a crossover fashion during the second and third periods. Total symptom scores did not differ significantly and no specific patterns were evident in the bacterial flora. These observations support the hypothesis that microbial flora is an associated factor in reflux gastritis syndrome and may play an important role only in certain individual patients.