Abstract
Introduction. The pathogenesis of GERD is strongly related with mixed acid and bile reflux. Benign and malignant esophageal and gastric lesions have been associated with synergetic activity between those parameters. Bile reflux causes reactive gastropathy evaluated with Bile Reflux Index (BRI). The aim was to investigate if the sequence: bile reflux-intestinal metaplasia-GERD-esophagitis, is associated with apoptotic/oncogenetic disturbances. Materials/Methods. Fifteen asymptomatic subjects and 53 GERD patients underwent gastroscopy with biopsies. The specimens examined histologically and immunohistochemically for p53, Ki-67, Bax, and Bcl-2. Results. Elevated BRI score detected in 47% (25/53) of patients with GERD and in 13% (2/15) of controls (P = 0.02). Severe esophageal lesions were significantly more common in BRI (+) patients (14/25) compared to BRI (−) ones (P = 0.0049). Immunohistochemical analysis did not show associations between BRI score and biomarker expression. Conclusions. Bile reflux gastropathy is associated with GERD severity, but not with oncogene expression or apoptotic discrepancies of the upper GI mucosa.
Highlights
The pathogenesis of gastroesophageal reflux disease (GERD) is strongly related with mixed acid and bile reflux
We reported that the presence of bile reflux gastropathy in patients with GERD was associated with more severe disease [19]
Demographic, clinical, endoscopic and histological data of GERD patients and healthy controls are shown in Tables 1 and 2
Summary
The pathogenesis of GERD is strongly related with mixed acid and bile reflux. Benign and malignant esophageal and gastric lesions have been associated with synergetic activity between those parameters. Bile reflux gastropathy is associated with GERD severity, but not with oncogene expression or apoptotic discrepancies of the upper GI mucosa. The gastroesophageal reflux disease (GERD) represents one of the most common gastrointestinal disorders, especially in the western countries [1, 2] It is the result of the exposure of the esophageal mucosa to acidic gastric juice and/or bilecontaining duodenal refluxates via an incompetent lower esophageal sphincter. The highest esophageal exposure to bile has been observed in patients with Barrett’s dysplasia and esophageal adenocarcinoma It has been associated with erosive oesophagitis, Barrett’s esophagus without dysplasia, and intestinal metaplasia of the gastric antrum [8,9,10,11,12,13,14,15]
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