Functional dyspepsia (FD) is a chronic gastrointestinal disorder defined by upper abdominal symptoms considered to originate from the gastroduodenal region with no structural disease on routine investigation, including upper gastrointestinal endoscopy.1 A meta-analysis using a broad definition reported that the global prevalence of uninvestigated dyspepsia is 21.0%, with a higher prevalence in women, smokers, users of NSAIDs, and in those with
Reflux of duodenal contents to the stomach and then to the esophagus is a short-term physiological event rarely leading to symptoms.5 Excessive duodenogastric reflux (DGR) occurs very commonly in adults secondary to partial gastrectomy, pyloroplasty, and cholecystectomy.6 The role of DGR of bile in the pathogenesis of FD was investigated in a few studies. One study comparing patients with FD and healthy subjects using bilirubin concentration monitoring (Bilitec 2000, Medtronic) revealed that significant longer periods of bilirubin exposure are observed in patients with FD and the total number of reflux and the number of reflux episode, lasting over 5 minutes were also higher.7 However, there are few studies on the association of bile reflux, FD, severity of symptoms, and response to treatment in FD patients undergoing cholecystectomy.
In this issue of the
This study has limitations because it is retrospective study and has referral bias because this study was conducted in a tertiary center. In addition, since there was no data for
For the treatment of dyspepsia with DGR, both sucralfate and rabeprazole therapies are known to be effective treatment options for the dyspeptic symptoms and histologic improvement compared with placebo.10 Domperidone can also significantly decrease the nocturnal duodenogastric bile reflux compared with placebo in patients with nocturnal dyspeptic symptoms and increased duodenogastric bile reflux time (intragastric bilirubin absorbance > 0.14).11 Although the treatment options of patients with DGR are not thought to be different from the general FD treatment, in this study, a high rate of taking narcotics in patients who had undergone cholecystectomy was reported. Therefore, when treating FD patients with DGR, it is necessary to consider the possibility of patients not responding well to general FD treatments such as proton pump inhibitors, prokinetics, and mucoprotectives. In order for bile reflux to be recognized as one of the important causes of FD, more studies on pathophysiology and effective therapeutics are needed in the future.
Bile reflux gastropathy and functional dyspepsia
Lake A, Rao SSC, Larion S, Spartz H, Kavuri S