Relationship between Bile Reflux and the Severity of Gastric Mucosal Damage in Patients with Dyspepsia.

Background: Bile acid reflux stands out as a notable risk factor for dyspepsia. Among patients with bile acid reflux, prevalent endoscopic observations encompass mucosal erythema, the detection of bile acid on the mucosa, erosion, hyperugosity, and gastric mucosal atrophy. This study aimed to elucidate the association between bile acid levels in gastric fluid and the degree of gastric mucosal damage. Methods: A cross-sectional investigation involved dyspeptic patients who underwent endoscopy at Prof. Dr. I.G.N.G. Ngoerah Denpasar Hospital. Bile acid analysis was conducted through the enzymatic calorimetric method, while assessment of mucosal damage relied on the Lanza score, evaluated independently by two observers. Mucosal damage severity was categorized as either mild (score 0-2) or severe (score 3-5). Cohen’s kappa analysis, bivariate, and logistic regression analysis was empoyed. Results: Among the 99 subjects involved, 58.6% were male. H. pylori antibodies were detected in 21% of the participants, while 48% exhibited a pH below 2.77.Additionally, 48% reported a history of NSAID consumption. The mean bile acid level in gastric fluid was 156.07 μmol/L, with a median of 170.09 μmol/L (categorized as high if ≥170.09 μmol/L, and low if <170.09 μmol/L). During endoscopic examination, mild mucosal damage was observed in 61%, and severe damage in 39% (kappa 1, P<0.001). A statistically significant relationship between gastric fluid bile acid levels and mucosal damage was evident (P<0.05). Conclusion: This study concludes that there was a relationship between the level of bile acid in gastric fluid and the degree of mucosal damage. [ABSTRACT FROM AUTHOR]