Bile Reflux Gastropathy and Functional Dyspepsia

Abstract

Background/aims: The pathoetiology of functional dyspepsia remains unclear; one mechanism could be chemical gastropathy from chronic bile reflux. We aim to examine the association of bile reflux gastropathy with functional dyspepsia and identify predisposing factors.

Methods: In a retrospective study, patients with functional dyspepsia (Rome III) who completed symptom assessment, esophagogastroduodenoscopy, and biopsies were categorized into 3 groups; bile gastropathy (BG), non-bile gastropathy (NBG), and no gastropathy (NG). Demographics, symptoms, endoscopy, and motility data were compared between groups. Multivariate analysis identified clinical factors associated with BG.

Results: Of 262 patients (77.5% female), 90 had BG, 121 had NBG, and 51 had NG. Baseline demographics were similar, however, patients with BG reported significantly more severe abdominal pain than NBG or NG groups (P = 0.018). Gastric erythema was significantly more common in BG vs NBG groups (P < 0.001). Cholecystectomy was significantly associated (OR, 6.6; P = 0.003) with the presence of gastropathy in BG compared to NBG or NG group. Patients with cholecystectomy had significantly more severe abdominal pain (P < 0.05), gastric erythema (P < 0.03), and gastritis (P < 0.05), and were more likely to be prescribed narcotic medications (P < 0.004) than patients without cholecystectomy.

Conclusion: s Bile reflux gastropathy is associated with functional dyspepsia and causes more severe symptoms. Cholecystectomy predisposes to BG and abnormal pain, and could contribute to the pathogenesis of functional dyspepsia.

Keywords: Bile reflux; Cholecystectomy; Dyspepsia; Gastritis.

Figure 1

(A) Characteristic endoscopic appearance of bile gastropathy with a large pool of thick yellowish-green bile noted in the antrum, and an underlying erythematous, inflamed gastric mucosa, indicative of bile gastritis/gastropathy after aspiration of bile. (B) Biopsy of gastric mucosa showing cork-screwing of foveolar glands (red arrow) and splaying of smooth muscle into the lamina propria (black arrows), typical of bile-induced chemical gastropathy. No significant inflammation is seen in the lamina propria.

Figure 2

Consort flow diagram of subjects with functional dyspepsia including the proportion of patients with a history of cholecystectomy (*P < 0.05).

Figure 3

Proportion of patients with severe (score > 7) gastrointestinal symptoms in the 3 cohorts with functional dyspepsia (*P < 0.05).