Background
Synergetic activity between acid and bile has been associated with extensive esophageal mucosal damage in patients with gastro-esophageal reflux disease (GERD). Reflux of bile causes injury to gastric mucosa evaluated with an established histological index (bile reflux index, BRI). The aim of the study was to investigate the role of bile reflux in patients with GERD using the BRI.
Material and Method
Fifteen asymptomatic subjects and 53 patients with GERD underwent upper gastrointestinal endoscopy with biopsies taken from the gastric antrum, body, cardia, and lower esophagus. The updated Sidney system was used for histological examination and BRI was calculated according to the findings in the antrum.
Results
BRI was elevated in 25/53 GERD patients (47%) and in 2/15 15 controls (13%) (OR: 5.8, 95%CI: 1.2-28.3). Elevated BRI was noted in 72% (13/18) of the patients with severe esophagitis (grade B or C) or Barrett's esophagus, whereas it was present in 34% (12/35) of those with mild or no lesions (OR: 5, 95%CI: 1.4-17.3). Additionally, 5 of the 6 patients detected with intestinal metaplasia (IM) at the cardia (83%) and 9 of the 12 patients with IM of the antrum (75%) had elevated BRI.
Conclusions
Bile reflux gastropathy is present in a significant proportion of patients with GERD and associated with disease severity. The elevated BRI in such patients highlights the role of duodeno-gastro-esophageal reflux as an additional factor in the pathogenesis of GERD.

Keywords: Gastroesophageal Reflux - pathology, Demography, Bile Reflux - pathology, Aged, 80 and over, Adolescent