Midwestern University, Mountain Vista Medical Center Mesa, AZ, United States
Preeyanka Sundar, MD, MPH1, Suma Harsha Kosuru, MBBS2, Tushar Gohel, MD, CNSC3, Sara Ancello, DO4 1Midwestern University, Mountain Vista Medical Center, Mesa, AZ; 2Mountain Vista Medical Center, Aldie, VA; 3Reddy GI Associates, Gilbert, AZ; Midwestern University, Mountain Vista Medical Center, Mesa, AZ; 4Central Arizona Medical Associates, Mesa, AZ
Introduction: Bile reflux gastritis (BRG), first described in 1800s, occurs due to retrograde flow of bile resulting in clinical, endoscopic, and histologic alterations similar to reactive gastritis. BRG has no clear evidence-based pharmacological approach. We systematically reviewed the literature and analyzed treatments for BRG.
Case Description/Methods: In one placebo controlled (PC) trial, Ursodeoxycholic acid had 80% symptomatic improvement but no significant change in endoscopy or histology. Similar findings were observed in another PC trial with 72% symptomatic improvement with Pantoprazole and hydrotalcite. Sucralfate improved histology in one study with 8/11 patients, but not symptoms or endoscopy. A double-blind trial with Cisapride showed improvement in symptoms and endoscopic score but no variation in histologic score. A RCT using Rabeprazole, Hydrotalcite, and a combination, 74% symptoms were relieved, most significantly in the combination group (88%), but no significant differences in endoscopy or histology. Two PC studies involved cholestyramine and cholestyramine-alginates combination, but the results were ineffective. An RCT with sucralfate, rabeprazole, both were able to significantly reduce symptom scores (90%), endoscopic (87%), and histologic signs (85%) compared to the observation group.
Discussion: This review suggests that there is a low quality of available research to develop treatment protocols and long-term PC trials are required to more determine the efficacy of different therapies for BRG.
Figure: A. Literature Review, Study Analysis. B. Literature Review Inclusion and External Criterias and Outcomes of Interest. C. Proposed Treatment Algorithm for Bile Reflux Gastritis.
Preeyanka Sundar indicated no relevant financial relationships.
Suma Harsha Kosuru indicated no relevant financial relationships.
Tushar Gohel indicated no relevant financial relationships.
Sara Ancello indicated no relevant financial relationships.
Preeyanka Sundar, MD, MPH1, Suma Harsha Kosuru, MBBS2, Tushar Gohel, MD, CNSC3, Sara Ancello, DO4. P1040 - Pharmacological Approaches to Bile Reflux Gastritis: A Systemic Literature Review, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.