Reflux gastritis.

Abstract

Examination of biopsies from post-operative stomachs led to a realisation that a hitherto poorly documented histological picture was consistently found in patients with entero-gastric reflux. This "reflux gastritis" is characterized by foveolar hyperplasia, oedema and vasodilatation in the lamina propria, and a paucity of acute and chronic inflammatory cells. The severity of reflux gastritis is significantly related to high bile acid levels in fasting gastric juice and to a high pH-possibly reflecting alkaline reflux. Of further interest, reflux gastritis scores are inversely related to H. pylori positivity. We have demonstrated that DU patients, who are almost universally H. pylori positive preoperatively, develop a H. pylori negative reflux gastritis following operations that permit entero-gastric reflux, but not after highly selective vagotomy. The disappearance of H. pylori in reflux is likely to be a consequence of disruption of the mucus-bicarbonate barrier and the bile and acid intolerance of the organism. Recognition of reflux gastritis is important for the histopathologist in providing an explanation for marked foveolar hyperplasia in the absence of an inflammatory cell infiltrate. This appearance has frequently been interpreted as pre-malignant dysplasia instead of the simple regenerative change that it represents. It is also important for the clinician in providing a correlate with symptomatology, and for predicting those patients who are most likely to benefit from restorative (bile-diverting) surgery.(ABSTRACT TRUNCATED AT 250 WORDS)