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Spontaneous bile reflux in the elderly

A F Safe1, O M Nwose, L Sheehan

  • 1Department of Medicine, Bristol Royal Infirmary, UK.

Gerontology
|January 1, 1993
PubMed
Summary
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Spontaneous bile reflux is uncommon in elderly individuals, even those with dyspepsia. Bile reflux does not cause the reduced stomach acid (hypochlorhydria) often seen in older adults.

Area of Science:

  • Gastroenterology
  • Geriatric Medicine
  • Digestive Health

Background:

  • Duodenogastric bile reflux is frequently observed in post-gastric surgery patients and occasionally in those with intact stomachs.
  • Spontaneous bile reflux in elderly populations, particularly those experiencing dyspepsia, remains understudied.

Purpose of the Study:

  • To investigate the prevalence and characteristics of spontaneous bile reflux in elderly dyspeptic patients compared to younger controls.
  • To assess the relationship between bile acid levels, gastric pH, Helicobacter pylori infection, and gastritis in the elderly.

Main Methods:

  • Fasting gastric juice samples were collected to measure total bile acid (TBA) levels and pH.
  • Antral biopsies were performed for histological examination and identification of Helicobacter pylori.

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  • Patients included dyspeptic elderly individuals, elderly controls, and young controls.

    • Main Results:

    • Elderly patients with gastritis exhibited significantly higher TBA levels than control groups.
    • Abnormal TBA levels (> 1 mmol/l) were found in only 10% of elderly patients with gastritis and 7% with gastric ulcers.
    • No significant difference in TBA levels was observed between H. pylori positive and negative patients. NSAID use was linked to reactive gastritis in elderly patients with normal TBA.

    Conclusions:

    • Spontaneous bile reflux is infrequent in the elderly population.
    • The hypochlorhydria common in the elderly is not attributed to alkaline bile reflux.
    • Non-steroidal anti-inflammatory drugs (NSAIDs) are identified as the primary cause of reactive gastritis in elderly individuals.