TO THE EDITOR: Factors that can contribute to bile reflux gastritis are generally categorized as primary biliary reflux and secondary biliary reflux after gastric resection with ablation of the pylorus. Primary biliary reflux is excessive bile in the duodenum retrograding to the stomach. Risk factors include gallbladder dyskinesia, gastric or duodenal dysmotility, and surgical resection such as cholecystectomy and sphincterotomy. Recently, a new analysis for the old problem of primary bile reflux gastropathy has been reported,1 in which a total of 262 patients with functional dyspepsia (FD) were stratified into 3 cohorts: bile gastropathy (BG), non-bile gastropathy (NBG), and no gastropathy (NG). The evaluations based on phenotype, symptoms, endoscopic and histological changes, etc. were compared using chi-square test for continuous data, Kruskal–Wallis test (one-way analysis of variance) for continuous data, and multivariate regression for 2 binary modeling.
The findings of this study are mainly featured or established with some characteristics to BG, in contrast to BNG and NG. Following aspects from BG, versus to BNG and NG, are significantly more severe or increased: (1) abdominal pain, (2) prevalence of cholecystectomy, (3) prevalence of gastric erythema in endoscopic examination, (4) prevalence of gastritis, (5) edema, and (6) chronic active inflammation on pathological examination. Indeed, this is a more comprehensive study, and its cohort analysis could be potentially informative in the diagnosis of bile reflux gastritis in clinical practice though it is not the criteria.
However, a few of concerns raised from this study may be worth to further discussing for clarification and understanding. First, the subjects included in the study were patients with FD, therefore, delayed gastric emptying was crucial and expected. In the literature, significantly longer delayed gastric emptying and higher bilirubin concentrations were observed in patients with bile reflux gastritis.2,3 The validation of the wireless motility capsule testing used in the study may need to adjust/compare with traditional or universally accepted measurements,4 since the supplementary results showing delayed gastric emptying in BG, NBG, and NG are respectively 38.6%, 40.4%, and 39.1% (
As commented,5 “role of bile reflux in functional dyspepsia: areas that need further research,” there are few studies on the association of bile reflux, FD, the severity of symptoms, and response to treatment in patients with FD undergoing cholecystectomy. As one of the important causes of FD,
Chun Yao and Linlin Liu equally contributed to this paper. Chun Yao and Linlin Liu wrote the draft; Meng Xia is responsible for data analysis; and Jianlin Lv as corresponding author made revisions and corrections on the manuscript.