Helicobacter pylori infection over bile reflux: No influence on the severity of endoscopic or premalignant gastric lesion development

Abstract

Helicobacter (H.) pylori infection and duodenogastric reflux (DGR) are both linked to endoscopic and premalignant gastric lesion development, but it is still unclear whether they are independent or have a causal relationship. This study investigated the histologic gastric changes in patients with primary DGR and H. pylori infection, as well as their endoscopic findings, symptoms, drug consumption, and social behavior in comparison with patients presenting only DGR. The study included 560 patients with primary DGR on endoscopy divided into two groups, according to the presence/absence of H. pylori infection on biopsy (utilizing usual stainings and immunohistochemical methods). There was no significant difference in terms of age and sex, nor in the frequency of diabetes or esophagitis between the studied groups. Epigastric pain was associated with H. pylori-positive biopsies in multivariate logistic regression analysis (P=0.005). Although without statistical significance, severe endoscopic lesions and premalignant gastric lesions were more frequent in the H. pylori group (45.1 vs. 28.4% and 37.4 vs. 32.3%, respectively). In patients with DGR, the final multivariate model revealed a positive association between smoking and immunohistochemically confirmed H. pylori infection (P=0.02, OR=1.88, 95% confidence intervals (CI)=1.10 to 3.21), but a negative effect of proton pump inhibitor consumption (P<0.001, OR=0.50, 95% CI=0.35 to 0.73). In conclusion, in patients with H. pylori infection and DGR, epigastric pain was the main reason for the endoscopic investigation. H. pylori infection over DGR did not influence the severity of endoscopic or premalignant gastric lesion development. Furthermore, smoking is directly related to immunohistochemically assessed active H. pylori infection in patients with bile reflux.

Deoxycholic acid induces gastric intestinal metaplasia by activating STAT3 signaling and disturbing gastric bile acids metabolism and microbiota

“…32.2%), but the association was not statistically significant. 51 Mechanistically, chronic Hp infection contributes to antroduodenal motility disorder, which indirectly induces the retrograde passage of alkaline duodenal content into the stomach. 51 Additionally, the presence of DGR does not interfere with the presence and severity of H. pylori .…”

“… 51 Mechanistically, chronic Hp infection contributes to antroduodenal motility disorder, which indirectly induces the retrograde passage of alkaline duodenal content into the stomach. 51 Additionally, the presence of DGR does not interfere with the presence and severity of H. pylori . 52 Therefore, together with our findings presented herein, the eradication of Hp without the treatment of DGR might not be sufficient to prevent gastric epithelial carcinogenesis.…”

Pyloric Incompetence Associated with Helicobactor pylori Infection and Correlated to the Severity of Atrophic Gastritis

“…Interestingly, Szőke et al demonstrated that smoking is associated with H. pylori infection in patients with DGR [28]. Smoking has already been proposed as a risk factor for pyloric incompetence [16,22].…”

“…It implies that pyloric incompetence may be affected by the presence of an H. pylori infection. However, the relationship has still been controversial [27,28]. The causative mechanism of H. pylori infection for DGR remains unclear.…”

The Agreement between Endoscopic and Histopathological Findings of Esophageal and Gastroduodenal Lesions and Its Relationship with Endoscopists’ Experience

“…In other studies, 7 , 8 the same lesions secondary to H. pylori infection or bile reflux have been reported as the most common endoscopic findings. 9 …”