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原发性胆汁反流性胃炎相关危险因素和诊断方法的研究进展
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Abstract:
原发性胆汁反流性胃炎(PBRG)是指在未进行过上消化道手术的情况下，由多种因素作用，致使胃肠功能失调，引起胆汁、胰液以及十二指肠液等内容物逆流而上进入胃内，破坏胃黏膜屏障，从引起反酸、烧心、恶心、呕吐、腹胀等临床症状的慢性炎症。就其患病率而言，有研究表明，在腹痛患者中胆汁反流的检出率约23.9%。近年来多项研究证实，原发性胆汁反流不仅与上消化道慢行炎症、糜烂、出血有关，还与肠化生、异型增生和癌变的发生有着紧密联系。然而，可以引起胆汁反流的因素纷繁多杂，比如年龄、性别、吸烟、饮酒、胆囊疾病、幽门螺杆菌感染、饮食习惯，乃至心理因素等均有研究发现与其相关。PBRG由于缺乏统一的医学指南，诊断方法也各有标准，因此，导致了临床医生对此病的认识和理解也各有不同。本文基于现有的最佳证据，对其复杂的发病机制、多样的相关因素和现代诊断方法进行综述，以帮助临床医生对此疾病能正确认识和及早鉴别。
Primary bile reflux gastritis (PBRG) is a condition where the gastrointestinal system malfunctions, causing the backflow of bile, pancreatic juice, and contents from the duodenum into the stomach. This happens without any history of upper gastrointestinal surgery. The continuous reflux of these substances damages the protective lining of the stomach, leading to chronic inflammation. As a result, patients experience common symptoms such as acid reflux, heartburn, nausea, vomiting, and abdominal distension. Regarding the prevalence of PBRG, research studies have found that about 23.9% of patients with abdominal pain show signs of bile reflux. In recent years, further investigations have revealed that primary bile reflux not only leads to inflammation, erosion, and bleeding in the upper gastrointestinal tract but also plays a crucial role in the development of intestinal metaplasia, dysplasia, and even carcinogenesis. The causes of bile reflux are numerous and diverse. Factors such as age, gender, smoking, alcohol consumption, gallbladder disease, Helicobacter pylori infection, dietary habits, and even psychological factors have all been linked to PBRG. One of the challenges in diagnosing PBRG is the absence of standardized medical guidelines and consistent diagnostic criteria. Different clinical doctors may have different understandings of this disease due to this lack of uniformity. To address this, the article relies on the best available evidence to provide a comprehensive review of the complex pathogenesis of PBRG, the wide array of associated factors, and the modern diagnostic methods. This aims to assist clinical doctors in accurately comprehending and promptly identifying this disease in their patients.
| [1] | 高瑞梅. 原发性胆汁反流性胃炎患者胃排空及胃黏膜胃动素、血管活性肠肽表达的研究[D]: [硕士学位论文]. 青岛: 青岛大学, 2010. |
| [2] | 李立胜. 原发性胆汁反流性胃炎患者血清胃泌素与血浆胃动素水平的临床观察[J]. 中国基层医药, 2015, 22(23): 3591-3593. |
| [3] | Shi, Y., Wei, Y., Zhang, T., Zhang, J., Wang, Y. and Ding, S. (2016) Deoxycholic Acid Could Induce Apoptosis and Trigger Gastric Carcinogenesis on Gastric Epithelial Cells by Quantitative Proteomic Analysis. Gastroenterology Research and Practice, 2016, Article ID: 9638963. https://doi.org/10.1155/2016/9638963 |
| [4] | Tarnawski, A., Ahluwalia, A. and Jones, M. (2012) Gastric Cytoprotection Beyond Prostaglandins: Cellular and Molecular Mechanisms of Gastroprotective and Ulcer Healing Actions of Antacids. Current Pharmaceutical Design, 19, 126-132. https://doi.org/10.2174/13816128130117 |
| [5] | 陈东风, 杨洋. 胆汁反流对食管胃黏膜屏障的损伤机制[J]. 中华消化杂志, 2016, 36(6): 363-365. |
| [6] | Othman, A.A.A., Dwedar, A.A.Z., ElSadek, H.M., AbdElAziz, H.R. and Abdelrahman, A.A.F. (2021) Bile Reflux Gastropathy: Prevalence and Risk Factors after Therapeutic Biliary Interventions: A Retrospective Cohort Study. Annals of Medicine and Surgery, 72, Article ID: 103168. https://doi.org/10.1016/j.amsu.2021.103168 |
| [7] | Lake, A., Rao, S.S.C., Larion, S., Spartz, H. and Kavuri, S. (2021) Bile Reflux Gastropathy and Functional Dyspepsia. Journal of Neurogastroenterology and Motility, 27, 400-407. https://doi.org/10.5056/jnm20102 |
| [8] | Stathopoulos, P., Zündt, B., Spelsberg, F.W., Kolligs, L., Diebold, J., Göke, B., et al. (2006) Relation of Gallbladder Function and Helicobacter pylori Infection to Gastric Mucosa Inflammation in Patients with Symptomatic Cholecystolithiasis. Digestion, 73, 69-74. https://doi.org/10.1159/000092746 |
| [9] | McCabe, M.E. and Dilly, C.K. (2018) New Causes for the Old Problem of Bile Reflux Gastritis. Clinical Gastroenterology and Hepatology, 16, 1389-1392. https://doi.org/10.1016/j.cgh.2018.02.034 |
| [10] | Kawai, Y., Tazuma, S. and Inoue, M. (2001) Bile Acid Reflux and Possible Inhibition of Helicobacter pylori Infection in Subjects without Gastric Surgery. Digestive Diseases and Sciences, 46, 1779-1783. https://doi.org/10.1023/a:1010678210019 |
| [11] | Taşcı, E.K., Karakoyun, M., Sezak, M., Doğanavsargil, B., Çetin, F. and Aydoğdu, S. (2022) Does Bile Reflux Reduce Helicobacter pylori Gastritis? The Turkish Journal of Pediatrics, 64, 122-126. https://doi.org/10.24953/turkjped.2020.2839 |
| [12] | Szőke, A., Mocan, S. and Negovan, A. (2021) Helicobacter pylori Infection over Bile Reflux: No Influence on the Severity of Endoscopic or Premalignant Gastric Lesion Development. Experimental and Therapeutic Medicine, 22, Article No. 766. https://doi.org/10.3892/etm.2021.10198 |
| [13] | Sugano, K., Tack, J., Kuipers, E.J., et al. (2015) Kyoto Global Consensus Report on Helicobacter pylori Gastritis. Gut, 64, 1353-1367. https://doi.org/10.1136/gutjnl-2015-309252 |
| [14] | Agin, M. and Kayar, Y. (2019) The Effect of Primary Duodenogastric Bile Reflux on the Presence and Density of Helicobacter pylori and on Gastritis in Childhood. Medicina, 55, Article No. 775. https://doi.org/10.3390/medicina55120775 |
| [15] | Maity, P., Biswas, K., Roy, S., Banerjee, R.K. and Bandyopadhyay, U. (2003) Smoking and the Pathogenesis of Gastroduodenal Ulcer-Recent Mechanistic Update. Molecular and Cellular Biochemistry, 253, 329-338. https://doi.org/10.1023/a:1026040723669 |
| [16] | Peng, Z., Wang, R., Wu, N., Gao, H., Gao, H. and Li, D. (2023) Assessment of the Risk Factors of Duodenogastric Reflux in Relation to Different Dietary Habits in a Chinese Population of the Zhangjiakou Area. Food & Nutrition Research, 67. https://doi.org/10.29219/fnr.v67.9385 |
| [17] | Lim, K.P.K., Lee, A.J.L., Jiang, X., Teng, T.Z.J. and Shelat, V.G. (2023) The Link between Helicobacter pylori Infection and Gallbladder and Biliary Tract Diseases: A Review. Annals of Hepato-Biliary-Pancreatic Surgery, 27, 241-250. https://doi.org/10.14701/ahbps.22-056 |
| [18] | Chiappetta, S., Lainas, P., Kassir, R., Valizadeh, R., Bosco, A. and Kermansaravi, M. (2022) Gastroesophageal Reflux Disease as an Indication of Revisional Bariatric Surgery—Indication and Results—A Systematic Review and Metanalysis. Obesity Surgery, 32, 3156-3171. https://doi.org/10.1007/s11695-022-06183-w |
| [19] | Lee, S.P., Sung, I., Kim, J.H., Lee, S., Park, H.S. and Shim, C.S. (2015) The Effect of Emotional Stress and Depression on the Prevalence of Digestive Diseases. Journal of Neurogastroenterology and Motility, 21, 273-282. https://doi.org/10.5056/jnm14116 |
| [20] | Ovsyannikov, V.I., Berezina, T.P. and Shemerovskii, K.A. (2015) Mechanisms of Discoordination of Contractile Activity in the Gastroduodenal Zone during Psychogenic Stress in Rabbits. Bulletin of Experimental Biology and Medicine, 159, 446-449. https://doi.org/10.1007/s10517-015-2987-5 |
| [21] | Akhmedov, V.A. and Ostapenko, V.A. (2009) Psychoemotional and Humoral Changes in Patients with Combined Reflux Disorders. Terapevticheskiĭ Arkhiv, 81, 24-27. |
| [22] | Filpa, V., Moro, E., Protasoni, M., Crema, F., Frigo, G. and Giaroni, C. (2016) Role of Glutamatergic Neurotransmission in the Enteric Nervous System and Brain-Gut Axis in Health and Disease. Neuropharmacology, 111, 14-33. https://doi.org/10.1016/j.neuropharm.2016.08.024 |
| [23] | Yang, X. (2015) Anxiety and Depression in Patients with Gastroesophageal Reflux Disease and Their Effect on Quality of Life. World Journal of Gastroenterology, 21, 4302-4309. https://doi.org/10.3748/wjg.v21.i14.4302 |
| [24] | Li, D., Zhang, J., Yao, W.Z., Zhang, D.L., Feng, C.C., He, Q., et al. (2020) The Relationship between Gastric Cancer, Its Precancerous Lesions and Bile Reflux: A Retrospective Study. Journal of Digestive Diseases, 21, 222-229. https://doi.org/10.1111/1751-2980.12858 |
| [25] | Kamiya, T., Fukuta, H., Hagiwara, H., Shikano, M., Kato, T. and Imaeda, K. (2022) Disturbed Gastric Motility in Patients with Long-Standing Diabetes Mellitus. Journal of Smooth Muscle Research, 58, 1-10. https://doi.org/10.1540/jsmr.58.1 |
| [26] | Krishnasamy, S. and Abell, T.L. (2018) Diabetic Gastroparesis: Principles and Current Trends in Management. Diabetes Therapy, 9, 1-42. https://doi.org/10.1007/s13300-018-0454-9 |
| [27] | 孙敬平, 温彪. 非酒精性脂肪肝和胆汁反流性胃炎临床相关性分析[J]. 成都医学院学报, 2013, 8(3): 326-328. |
| [28] | Dai, F., Gong, J., Zhang, R., Luo, J., Zhu, Y. and Wang, X. (2002) Assessment of Duodenogastric Reflux by Combined Continuous Intragastric pH and Bilirubin Monitoring. World Journal of Gastroenterology, 8, 382-384. https://doi.org/10.3748/wjg.v8.i2.382 |
| [29] | Bollschweiler, E., Wolfgarten, E., Pütz, B., Gutschow, C. and Hölscher, A.H. (2005) Bile Reflux into the Stomach and the Esophagus for Volunteers Older than 40 Years. Digestion, 71, 65-71. https://doi.org/10.1159/000084521 |
| [30] | Zhao, A., Wang, S., Chen, W., Zheng, X., Huang, F., Han, X., et al. (2020) Increased Levels of Conjugated Bile Acids Are Associated with Human Bile Reflux Gastritis. Scientific Reports, 10, Article No. 11601. https://doi.org/10.1038/s41598-020-68393-5 |
| [31] | Eldredge, T.A., Myers, J.C., Kiroff, G.K. and Shenfine, J. (2017) Detecting Bile Reflux—The Enigma of Bariatric Surgery. Obesity Surgery, 28, 559-566. https://doi.org/10.1007/s11695-017-3026-6 |
| [32] | 李小东, 郭永涛, 赵洪刚, 张遵城, 王钦, 董萍, 肖连冬, 董华. 核素显像与胃镜对胆汁反流性胃炎的诊断价值[J]. 天津医药, 2006, 34(1): 20-21. |
| [33] | Vere, C.C.C.S., Comănescu, V., Mogoantă, L., Rogoveanu, I. and Ciurea, T. (2005) Endoscopical and Histological Features in Bile Reflux Gastritis. Romanian Journal of Morphology and Embryology, 46, 269-274. |
| [34] | Chao, Y., Chang, W., Lin, C. and Chuan, D. (2016) Duodenogastric Reflux: Proposed New Endoscopic Classification in Symptomatic Patients. Journal of Medical Sciences, 36, 1-5. https://doi.org/10.4103/1011-4564.177165 |
| [35] | 杨玉杰, 李永玲. 不同病因所致胆汁反流性胃炎的临床和内镜特点分析[J]. 医学食疗与健康, 2019(3): 242. |
| [36] | Shenouda, M.M., Harb, S.E., Mikhail, S.A.A., Mokhtar, S.M., Osman, A.M.A., Wassef, A.T.S., et al. (2017) Bile Gastritis Following Laparoscopic Single Anastomosis Gastric Bypass: Pilot Study to Assess Significance of Bilirubin Level in Gastric Aspirate. Obesity Surgery, 28, 389-395. https://doi.org/10.1007/s11695-017-2885-1 |
| [37] | Lin, J.K., Hu, P.J., Li, C.J., Zeng, Z.R. and Zhang, X.G. (2003) A Study of Diagnosis of Primary Biliary Reflux Gastritis. Chinese Journal of Internal Medicine, 42, 81-83. |
| [38] | Vaezi, M.F. and Richter, J.E. (2001) Duodenogastroesophageal Reflux and Methods to Monitor Nonacidic Reflux. The American Journal of Medicine, 111, 160-168. https://doi.org/10.1016/s0002-9343(01)00827-0 |
