Bile reflux is an independent risk factor for precancerous gastric lesions and gastric cancer: An observational cross‐sectional study

Abstract

Objective To identify whether bile reflux on endoscopy and other related variables are risk factors for precancerous gastric lesions and gastric cancer (GC). Methods A multicenter, cross‐sectional and observational study was conducted in five centers in China from June to October 2019, 1162 patients were recruited and divided into the chronic gastritis (CG), the precancerous lesion (low‐grade intraepithelial neoplasia and intestinal metaplasia), and GC groups (including high‐grade intraepithelial neoplasia). All participants underwent detailed interviews, endoscopy and biopsy, and completed questionnaires. Odds ratio and 95% confidence interval were calculated with multivariate logistic regression models with or without adjustment for Helicobacter pylori infection. Results We recruited 668 patients with CG, 411 with precancerous lesions and 83 with GC. By comparing the CG and precancerous lesion groups, independent risk factors for cancerous gastric lesions were the grade of bile reflux, patient's age, dietary habits and family history of GC. Similar results were obtained when comparing the CG and GC groups. In addition, bile reflux was confirmed as an independent risk factor for progression from precancerous lesions to cancer. Conclusions Bile reflux on endoscopy as well as age, dietary habits and a family history of GC were independent risk factors for the development of precancerous gastric lesions and GC.

Analysis of Risk Factors and Establishment of a Prediction Model for Endoscopic Primary Bile Reflux: A Single-Center Retrospective Study

“…Even now, the relationship between EPBR and H. pylori infection remains controversial (23). Several studies attempted to address the association of EPBR and H. pylori infection with the occurrence and development of chronic gastritis and gastric cancer (9,14,(24)(25)(26). One study implied that bile acid, which continued in gastric juice, had the extraordinary capabilities of promoting ulcer healing and inhibiting the growth of H. pylori (27).…”

“…The patients with pancreatic diseases included acute or chronic pancreatitis and pancreatic tumors. The selection principle of the 14 potential risk factors above for inducing or deteriorating EPBR mainly hinged on previous literature and our clinical practice experience (14)(15)(16)(17)(18).…”

Is intestinal metaplasia the point of no return in the progression of gastric carcinogenesis?

“…In GC and GPLs, a family history of GC could still be viewed as an independent risk, even for IM. [ 34 , 35 ] In a Chinese case-control study, the toll like receptor 4 ( TLR4 ) rs11536889C allele increased the risk of GC. [ 36 ] However, Nieuwenburg et al [ 35 ] indicated that TLR4 rs11536889C allele was inversely associated with the progression of IM.…”

“…A multicenter, cross-sectional and observational study showed that bile reflux and dietary habits were independent risk factors for the development of GPLs and GC. [ 34 ]…”

“…A multicenter, cross-sectional and observational study showed that bile reflux and dietary habits were independent risk factors for the development of GPLs and GC. [34] Prospect: The controversial perspective, IM was viewed as the point of no return, could be attributed to many different reasons. First, the short-term follow-up after H. pylori eradication was insufficient.…”