Biliary bile acid composition in gastric cancer

Abstract

Bile reflux into the stomach has been considered carcinogenic. Secondary bile acids, and in particular deoxycholic acid, have been shown to act experimentally as co-carcinogens in the colon and are increased in patients with colorectal adenocarcinoma. No information is available with respect to biliary bile acid composition in patients with gastric cancer. We studied biliary bile acid composition in 11 patients with gastric cancer and 23 healthy controls. Bile acids were measured using high-performance liquid chromatography. The site of gastric cancer was the antrum in 6 patients and body in 5. There were 6 intestinal-type and 5 diffuse adenocarcinomas. Only 2 patients had Helicobacter pylori infection. Deoxycholic acid constituted 24% +/- 2% of biliary bile acid in gastric cancer patients versus 22% +/- 2% in healthy controls (NS). Similarly, no differences were found between the two groups for all other bile acids. Deoxycholic acid constituted 23% +/- 3% of biliary bile acid (NS vs. controls) in patients with antral adenocarcinoma and 25% +/- 2% (NS vs. controls) in patients with intestinal-type gastric adenocarcinoma. Gastric adenocarcinoma is not associated with an increase in the more-toxic secondary bile acids, and deoxycholic acid in particular. This reduces the importance of bile acid composition as a promotor in gastric carcinogenesis.

Relation between reflux of bile acids into the stomach and gastric mucosal atrophy, intestinal metaplasia in biopsy specimens

“…(19) On the other hand, no differences were found in secondary bile acid composition, including deoxycholic acid, between stomach cancer patients and a control group. (20) Even in our own study, no differences in the incidence of reflux or in its concentration were seen among the peptic ulcer disease group, gastritis group, and normal group. We therefore carried out our study of reflux bile acids regardless of the disease.…”

“…Based on the fact that many differentiated stomach cancers develop in gastric mucosa that exhibit intestinal metaplasia, Matsukura et al (20) reported that intestinal metaplasia in the gastric mucosa is a precancerous condition. In a study by Uemura et al (30) there was a high rate of development of stomach cancer in subjects with H. pylori infection, especially in patients with severe atrophic gastritis and severe intestinal metaplasia.…”

Duodenogastric reflux and gastric stump carcinoma

“…Bile reflux is often observed after cholecystectomy; a cohort study therefore examined cholecystectomy as a risk factor for gastric cancer [55], but their finding showed that cholecystectomy did not seem to be associated with an increased risk of gastric cancer. Fracchia et al [56] studied biliary bile acid composition in gastric cancer patients and healthy controls, and found that gastric cancer was not associated with increased levels of the more toxic secondary bile acids, especially DCA. Of particular interest, we [57] experienced two patients with double choledochus with ectopic drainage into the stomach associated with early gastric carcinoma.…”

Functional, Diagnostic and Therapeutic Aspects of Bile

“… 49 Bile acid is toxic to the gastric mucosa and is also considered a risk factor for the development of gastric cancer. 50 Primary DGR can occur due to antroduodenal motility disorder. Secondary DGR generally follows surgical alteration of gastroduodenal anatomy (pyloroplasty, distal gastric resection with Billroth I or II reconstruction) or cholecystectomy.…”