Duodenogastric reflux is associated with antral metaplastic gastritis

Background: It has long been suspected that duodenogastric reflux plays a r ole in the pathogenesis of intestinal metaplasia (IM), although recent stud ies have demonstrated a close association between Helicobacter pylori Infec tion and gastroduodenal diseases, including IM. The objective of this study was to investigate the relation among IM and duodenogastric reflux, H pylo ri infection, and smoking. Methods: Subjects with "marked" characteristics of IM, all with extensive p repyloric distribution at endoscopy that was confirmed histologically, were studied as an IM group (27 men, 26 women; mean age, 64 years). A control g roup was comprised by subjects without characteristics of IM (29 men, 28 wo men; mean age, 63 years). Fasting pH, total bile acid concentration, and am monia concentration were measured in the gastric juice of all participants. Histologic examination endoscopic biopsy specimens were evaluated histolog ically. H pylori infection was determined by serum antibody and urease test ing, and by histology. Serum gastrin and pepsinogen concentrations, and gas tric emptying time were measured. Dietary, drinking, and smoking habits wer e recorded. Comparisons were made between groups and analyzed statistically . Results: The pH and total bile acid concentrations were significantly highe r in the IM group than the control group (p < 0.01). No significant differe nce in H pylori infection was found between the IM and control group. Smoki ng was associated with IM (odds ratio [OR], 15.74; 95% CI, 3.96 to 62.50). Conclusions: A high pH and total bile acid concentration and smoking were a ssociated with "marked" IM, suggesting that these factors may play a role i n the development of IM.