Is There any Relation between the Presence of Helicobacter Pylori Infection and Duodenogastric Reflux in Children?

INTRODUCTION: Although it is a bile-sensitive microorganism in vitro, Helicobacter pylori (Hp) has been detected in human bile and gallbladder tissue. Recently, it is reported that bile acids eliminate Hp after gastric surgery. However, the data about the relationship between Hp and bile acids in subjects without surgery are limited. We aimed to evaluate the clinical features and Hp gastritis rate among patients with and without reflux of gastric bile acid.
METHODS: Patient data were collected through reviewing medical records of 1–18-years old children who underwent gastroscopy during the study period. The rapid urease test (RUT) result, the presence of gastric or bulbar erosion/ulcer, and duodenogastric reflux (DGR) were obtained from gastroscopy reports. Histologic changes of alkaline gastritis and other types of gastritis were noted. Hp infection was accepted as “present” if both RUT and histopathological findings confirm the Hp presence.
RESULTS: Among 754 diagnostic esophago-gastro-duodenoscopy (EGD), 521 subjects were eligible. Bile was visible at the stomach in 114 children (mean age: 11.29±3.90 years, 76.3% girls). The remaining 407 children without bile in the stomach were served as controls (mean age: 9.09±4.53 years, 52.1% girls). Girl gender was a risk factor for bile in the stomach during EGD (aOdds Ratio [aOR]: 1.33, 95% confidence interval [CI]: 1.09–1.77, p<0.05). Hp was present in 35 (30.7%) subjects in the study group and 210 (51.6%) controls (OR: 1.68, 95% CI: 1.25–2.24, p<0.05). Foveolar hyperplasia was present in 98 (86.0%) cases in the study group and 2 (0.5%) controls. Alkaline gastritis was correlated with bile in the stomach (r2: 0.89, p<0.01), older age (r2: 0.18, p<0.01), and girl gender (r2: 0.21, p<0.01).
DISCUSSION AND CONCLUSION: The rate of Hp infection was lower in patients with DGR compared to controls. Furthermore, DGR was significantly more frequent in girls and grown-up children. A high percentage of patients with bile reflux had alkaline gastritis.