1. Introduction
Bile reflux gastritis (BRG), also known as alkaline reflux gastritis (ARG), refers to the chronic inflammation, erosion, and even ulceration in the gastric mucosa caused by excessive duodenal fluid (including bile, pancreatic, and intestinal fluid) refluxing into the stomach [1]. Bile reflux gastritis (BRG) is a significant yet often underappreciated gastrointestinal disorder characterized by the retrograde flow of bile from the duodenum into the stomach. BRG impacts the gastric mucosa and can lead to considerable patient discomfort and diminished quality of life [2].
The clinical manifestation of BRG includes symptoms such as epigastric pain, nausea, vomiting, and a bitter taste in the mouth. These symptoms often exacerbate after meals, particularly those high in fat, which stimulates bile secretion [3]. Endoscopic findings in BRG typically reveal bile-stained mucosa, erythema, and occasionally erosions or ulcers, which are pivotal in distinguishing it from other gastric conditions [4]. Bile reflux gastropathy is common after therapeutic biliary interventions being more common among obese and diabetic patients. Despite its clinical relevance, BRG remains less well understood compared to other gastrointestinal disorders, leading to a gap in effective management strategies and patient education.
The rationale for this comprehensive review stems from the growing recognition of BRG’s impact on patient health and the need for a thorough understanding of its prevalence, risk factors, management options, and prognosis. Previous studies have highlighted the variability in the prevalence of BRG in patients undergoing endoscopic evaluation for abdominal complaints [5]. This variability can be attributed to differences in diagnostic criteria and study methodologies, underscoring the need for standardized approaches to prevalence estimation.
The pathophysiology of BRG involves the retrograde flow of bile into the stomach, disrupting the gastric mucosal barrier and leading to inflammation and epithelial damage [5]. The management of BRG encompasses a range of approaches, from medical therapies such as bile acid sequestrants and prokinetic agents to surgical interventions for refractory cases. However, current treatment options often fall short of providing long-term relief, highlighting the need for ongoing research into more effective and durable solutions. Additionally, lifestyle and dietary modifications play a significant role in symptom management, yet their efficacy varies among individual to individual [2].
The prognosis for BRG varies widely among patients, with some achieving significant symptom relief through appropriate management, while others experience persistent symptoms and complications. Regular follow-up and surveillance are recommended to monitor for potential complications and optimize patient outcomes, while the specific costs may vary depending on factors such as geographic location, healthcare system, and the extent of testing and treatment required.
This narrative review aims to comprehensively explore bile reflux gastritis (BRG), encompassing its epidemiology, pathophysiology, clinical manifestations, diagnostic challenges, and therapeutic strategies. By systematically synthesizing available evidence, this review seeks to elucidate the prevalence, risk factors, and clinical course of BRG, identify diagnostic modalities, and evaluate the efficacy of various management options, ultimately contributing to a deeper understanding of this complex condition and informing future research and clinical practice.
2. Methods
A comprehensive literature search was undertaken to identify relevant studies on bile reflux gastritis (BRG). The PubMed, Embase, Google Scholar and Cochrane databases were systematically searched using a combination of keywords including “bile reflux gastritis,” “bile reflux,” “gastritis,” “prevalence,” “risk factors,” “management,” and “prognosis.” The search was limited to studies published up until December 2024.
To ensure the inclusion of high-quality and relevant studies, specific inclusion and exclusion criteria were established. Studies were included if they focused on human subjects, provided original data, and addressed the core themes of BRG prevalence, risk factors, management, and prognosis. Conversely, case reports, animal studies, and studies primarily centered on other gastrointestinal conditions were excluded.
The extracted data were meticulously synthesized to provide a comprehensive overview of BRG, encompassing its prevalence, risk factors, management options, and prognostic implications. A narrative synthesis approach was adopted to explore the heterogeneity of findings and to identify patterns, gaps, and inconsistencies within the literature. Critical interpretation of the evidence was emphasized to highlight strengths, limitations, and areas for future research. By adhering to a rigorous methodology, this review aimed to provide a reliable and informative synthesis of the available evidence on bile reflux gastritis.
3. Bile Reflux Gastritis (BRG)
3.1. Global Epidemiology
Bile reflux gastritis (BRG) is a condition that is gaining attention in gastroenterology due to its clinical implications and impact on patient quality of life. The prevalence of Bile reflux gastritis (BRG) varies significantly across different regions and populations. Bile reflux was found to be present in 23.9% of patients in research comprising 804 instances where an endoscopic examination was performed for abdominal pain [6]. Variation in prevalence is influenced by several factors, including diagnostic criteria, study populations, and methodologies. It’s important to note that the prevalence of BRG can differ significantly between regions. Local data for Saudi Arabia or other Middle Eastern countries is not readily available at this time.
Demographic Variations
The prevalence of Bile reflux gastritis (BRG) shows significant demographic variations. Research indicates a higher prevalence in older adults, which can be attributed to an increased incidence of cholecystectomy and other gastrointestinal surgeries in this age group [7]. Additionally, there is evidence suggesting a slight male predominance in Bile reflux gastritis (BRG) cases, although the underlying reasons for this gender disparity are not fully understood [4]. The condition is also more prevalent in populations with higher rates of obesity and diabetes, conditions that are known to affect gastrointestinal motility.
3.2. Pathophysiology and Mechanism
3.2.1. Biliary System Dysfunction
Figures 1(a)-(c) show endoscopic visualization of Bile Reflux disease. The pathogenesis of Bile reflux gastritis (BRG) involves the retrograde flow of bile from the duodenum into the stomach, resulting in mucosal injury and inflammation. This retrograde bile flow can be due to dysfunction of the pyloric sphincter or abnormalities in duodenogastric motility. The primary pathological mechanism involves bile acids disrupting the gastric mucosal barrier, leading to inflammation, epithelial damage, and ulceration [8]. The presence of bile acids in the stomach alters the normal pH environment, exacerbating mucosal damage and leading to symptomatic gastritis.
(a) (b) (c)
Figure 1. (a), (b), (c): Endoscopic visualization of bile reflux.
3.2.2. Interaction with Helicobacter pylori
The relationship between Helicobacter pylori infection and Bile reflux gastritis (BRG) remains a subject of ongoing research and debate. Some studies have suggested that H. pylori infection may exacerbate bile-induced gastric mucosal damage by disrupting the mucosal barrier and increasing bile acid permeability [9]. However, other research indicates that eradication of H. pylori may reduce the severity of Bile reflux gastritis (BRG) symptoms, suggesting a complex interplay between these two factors [10].
3.2.3. Molecular and Cellular Mechanisms
At the molecular level, bile acids are known to activate various signalling pathways that contribute to mucosal inflammation and damage. These include the nuclear factor-kappa B (NF-κB) pathway and the mitogen-activated protein kinase (MAPK) pathway, which are involved in the production of pro-inflammatory cytokines and chemokines [10]. Additionally, bile acids can induce oxidative stress and apoptosis in gastric epithelial cells, further contributing to mucosal injury and gastric cancer [11].
Risk Factors: Table 1 summarizes various risk factors for bile reflux gastritis.
Table 1. Summary of risk factors for bile reflux gastritis.
Risk Factor |
Description |
Disorders of gastrointestinal motility |
Gastroparesis, delayed gastric emptying, small bowel bacterial overgrowth [2] |
Surgical factors |
Gastrectomy, vagotomy, bariatric surgery [7] |
Sphincteric dysfunction and infections |
Pyloric sphincter dysfunction, sphincter of Oddi dysfunction [12] |
Biliary tract disease |
Cholelithiasis, biliary dyskinesia, primary sclerosing cholangitis. Biliary tract disease can lead to BRG by disrupting the normal flow of bile and increasing the pressure within the biliary system [13] |
3.2.4. Surgical History
A history of gastrointestinal surgery, particularly cholecystectomy and bariatric surgery, is a significant risk factor for developing Bile reflux gastritis (BRG). These procedures can alter normal biliary physiology, leading to increased bile reflux into the stomach [14]. Post-surgical anatomical changes, such as bile duct dilation can contribute to the pathogenesis of Bile reflux gastritis (BRG) [7].
3.2.5. Medication Use
Certain medications, including nonsteroidal anti-inflammatory drugs (NSAIDs) and aspirin, are associated with an increased risk of Bile reflux gastritis (BRG). These drugs can cause direct mucosal injury and increase bile acid permeability, exacerbating bile-induced gastric damage. Patients on long-term NSAID therapy should be monitored closely for symptoms of Bile reflux gastritis (BRG) and may require alternative medications or protective agents [15].
3.3. Impact of NSAIDs on Bile Reflux Gastritis (BRG)
NSAIDs can increase the risk of bile reflux gastritis. They damage the gastric mucosa, reduce prostaglandin production, and may affect sphincter function. This can lead to more bile reflux and irritate the stomach. Patients on long-term NSAID therapy should be monitored for symptoms of bile reflux gastritis and may need alternative medications or protective measures [16]-[19].
Interaction with Other Factors: NSAIDs may interact with other factors, such as Helicobacter pylori infection or underlying gastrointestinal conditions, to increase the risk of BRG [20].
3.4. Comorbid Conditions
Comorbid conditions such as diabetes mellitus and obesity are known to increase the risk of Bile reflux gastritis (BRG). These conditions can impair gastric motility and promote duodenogastric reflux, contributing to the development of Bile reflux gastritis (BRG). Effective management of these underlying conditions is essential to reduce the risk and severity of Bile reflux gastritis (BRG) [21].
3.5. Clinical Presentation
3.5.1. Symptomatology
Patients with Bile reflux gastritis (BRG) typically present with a range of symptoms, including epigastric pain, nausea, vomiting, and a bitter or sour taste in the mouth. These symptoms are often exacerbated after meals, particularly those high in fat, which stimulate bile secretion [22].
3.5.2. Diagnostic Criteria
The diagnosis of Bile reflux gastritis (BRG) is primarily based on clinical presentation, endoscopic findings, and histological examination. Endoscopy often reveals bile-stained gastric mucosa, erythema, erosions, and sometimes ulcers [15]. Histological examination is crucial for confirming the diagnosis and typically shows features such as foveolar hyperplasia, oedema, and the presence of bile acid crystals within the gastric epithelium [4]. Advanced diagnostic techniques, such as Bilitec monitoring, can measure bile reflux episodes by detecting bilirubin concentrations in the stomach (Table 2).
Table 2. Summary of diagnostic modalities for bile reflux gastritis.
Modality |
Description |
Advantages |
Limitations |
Endoscopy |
Direct visualization of gastric mucosa |
Provides visual evidence of gastritis, duodenitis, and bile staining |
Invasive,
operator-dependent, limited specificity [4] |
Bile acid
reflux testing |
Measurement of bile acid levels in gastric aspirates or duodenal contents |
Direct assessment of bile reflux |
Invasive, limited availability [23] |
Manometry |
Assessment of sphincter function and gastric motility |
Provides functional information |
Invasive, complex, limited availability [24] |
3.6. Differntial Diagnosis
Differentiating Bile reflux gastritis (BRG) from other types of gastritis, like Helicobacter pylori-associated gastritis, is essential for appropriate therapeutic management. Bile reflux gastritis (BRG) affects the stomach and upper duodenum while Helicobacter pylori gastritis often presents with similar symptoms but can be distinguished by specific endoscopic and histological features and by testing for H. pylori infection [5].
The diagnosis of BRG presents several challenges. Many BRG symptoms, such as epigastric pain, nausea, and vomiting, overlap with other gastrointestinal disorders, making it difficult to distinguish BRG from conditions like functional dyspepsia, peptic ulcer disease, and even gastroesophageal reflux disease (GERD). Furthermore, endoscopic findings of bile staining can be subjective and influenced by the endoscopist’s interpretation. Currently, there are no widely available, non-invasive biomarkers specifically for BRG. Distinguishing BRG from H. pylori-associated gastritis can also be challenging, as both conditions may present with similar symptoms and endoscopic findings. Several potential solutions and advances are being explored to improve the diagnosis of BRG. Research is ongoing to identify specific biomarkers, such as bile acid metabolites in breath or stool, or specific gene expression patterns in gastric biopsies, that could aid in the diagnosis of BRG. Standardization of endoscopic criteria for bile staining and other relevant findings could improve diagnostic accuracy. Techniques like endoscopic ultrasound (EUS) may help visualize the pyloric sphincter and assess for potential anatomic abnormalities contributing to BRG. While invasive, Bilitec monitoring provides objective evidence of bile reflux and can be valuable in specific cases. Finally, AI algorithms may be developed to analyze endoscopic images and other data to improve the accuracy and consistency of BRG diagnosis [4] [23] [24].
3.7. Therapeutic Management Stratergies
Drug Therapy and Combination Therapies for BRG: Table 3 describes the medical management of Bile reflux gastritis (BRG) focusing on symptom relief and reducing bile reflux.
Table 3. Drug therapy and combination therapies in BRG.
Drug or Combination |
Mechanism of Action |
Potential Benefits |
Potential Side Effects |
Ursodeoxycholic Acid (UDCA) |
Protects gastric mucosa, reduces reflux, improves antioxidant ability |
Reduces inflammation, improves symptoms |
Diarrhoea, abdominal pain, constipation [25] |
Hydrotalcite |
Neutralizes bile acids, enhances mucosal barrier |
Relieves abdominal discomfort |
Constipation, diarrhoea [26] |
Prokinetic Agents (e.g., metoclopramide, domperidone) |
Improves gastric emptying, reduces reflux |
May alleviate symptoms in some cases |
Extrapyramidal symptoms (e.g., tremors, dystonia), nausea, vomiting [27] |
UDCA + Hydrotalcite |
Synergistic effects in reducing inflammation and improving symptoms |
Potentially more effective than monotherapy |
May increase the risk of constipation or diarrhoea [25] |
Ursodeoxycholic Acid (UDCA): Bile acid that can protect the gastric mucosa, reduce reflux, and improve antioxidant ability. It has been shown to improve symptoms of BRG, such as epigastric pain and nausea, and may help to prevent the development of gastric ulcers. While generally well-tolerated, UDCA can sometimes cause diarrhoea or abdominal pain [25].
Hydrotalcite can neutralize bile acids, reducing their irritating effects on the gastric mucosa. It can help to relieve abdominal discomfort and heartburn associated with BRG. However, constipation is a common side effect of hydrotalcite [26].
Prokinetic Agents like metoclopramide and domperidone can improve gastric emptying and reduce reflux. They may be helpful in alleviating symptoms of BRG, especially if they are caused by delayed gastric emptying. However, prokinetic agents can sometimes cause side effects such as nausea, vomiting, and extrapyramidal symptoms (e.g., tremors, dystonia) [27].
The combination of UDCA and hydrotalcite can provide synergistic benefits by protecting the gastric mucosa and neutralizing bile acids. Studies have shown that this combination can be more effective than using either drug alone in treating BRG. However, it may increase the risk of constipation or diarrhea. It’s important to note that the optimal treatment for BRG may vary depending on the individual patient and the severity of their symptoms [25].
3.8. Surgical Interventions
For patients with refractory symptoms unresponsive to medical therapy, surgical options may be considered. Roux-en-Y gastric bypass is an effective intervention that diverts bile away from the stomach, thereby alleviating symptoms and promoting mucosal healing [28]. Another surgical approach is pyloroplasty, which improves pyloric sphincter function and prevents bile reflux. These surgical interventions are typically reserved for severe cases with significant impact on quality of life or complications such as gastric ulcers [7].
3.9. Lifestyle and Dietary Modifications
Table 4 summarizes different management options for Bile Reflux Gastritis. Lifestyle and dietary modifications are critical components of Bile reflux gastritis (BRG) management. Patients are advised to avoid foods and beverages that can trigger symptoms, such as fatty foods, chocolate, caffeine, and alcohol. Eating smaller, more frequent meals can help reduce bile reflux episodes. Patients should also avoid lying down immediately after meals and elevate the head of the bed to prevent nighttime reflux [30].
Table 4. Summary of management options for bile reflux gastritis.
Treatment |
Description |
Advantages |
Limitations |
Lifestyle modifications |
Weight loss, dietary changes, elevation of head of bed |
Non-invasive,
cost-effective |
Variable efficacy, patient adherence [29] |
Medical therapy |
Prokinetic agents, bile acid sequestrants |
Symptom relief, mucosal healing |
Potential side effects, variable efficacy [2] |
Surgical management |
Pyloroplasty, fundoplication |
Definitive treatment for refractory cases |
Invasive, associated with complications [7] |
3.10. Prognosis
3.10.1. Symptom Control
The prognostic trajectory of patients with Bile Reflux Gastritis (BRG) is contingent upon the efficacy of symptom management and the underlying etiological factors. With judicious implementation of medical and surgical interventions, a substantial proportion of patients can attain significant symptomatic amelioration and an enhanced quality of life. Precocious diagnosis and intervention are pivotal in mitigating the risk of complications and optimizing patient outcomes. While a considerable number of patients exhibit favorable responses to therapeutic modalities, a subset may experience recurrent symptomatology and the emergence of complications [2].
3.10.2. Potential Complications
Chronic BRG can lead to a spectrum of complications. Persistent exposure to refluxed bile can engender the development of peptic ulcers, potentially culminating in gastrointestinal hemorrhage or perforation. Furthermore, the retrograde flow of bile can elicit mucosal irritation within the esophagus, resulting in esophagitis. In instances of severe and persistent bile reflux, metaplastic changes can occur in the oesophageal epithelium, leading to the development of Barrett’s esophagus, a premalignant condition. While the precise pathophysiological mechanisms remain under investigation, a potential association between chronic BRG and an elevated risk of gastric neoplasia has been postulated. The probability of experiencing these complications may exhibit a positive correlation with the duration and severity of the BRG condition [8] [11] [27].
3.10.3. Long-Term Management
Regular clinical follow-up is imperative for the surveillance of potential complications and the assessment of therapeutic efficacy. In select cases, endoscopic surveillance may be warranted to monitor for the emergence of ulcerative lesions or other untoward sequelae [8].
3.10.4. Risk Factors for Gastric Neoplasia in BRG
Chronic Inflammation: BRG is characterized by a state of persistent mucosal inflammation, which can foster an environment conducive to the development of premalignant alterations and, potentially, neoplastic transformation.
Intestinal Metaplasia: Epidemiological studies have demonstrated an association between BRG and the development of intestinal metaplasia, a condition characterized by the replacement of the native gastric epithelium with intestinal-type mucosa. Intestinal metaplasia is recognized as a premalignant condition and carries an elevated risk of gastric neoplasia.
Oxidative Stress and DNA Damage: The presence of bile acids within the gastric milieu can induce oxidative stress and DNA damage within gastric epithelial cells, thereby contributing to the neoplastic process [31]-[33].
3.10.5. Important Considerations
The precise etiopathogenesis underlying the association between BRG and gastric neoplasia remains elusive: Further investigative endeavors are imperative to establish a definitive causal relationship and elucidate the underlying molecular mechanisms.
The development of gastric neoplasia is not an inevitable consequence of BRG: A substantial proportion of patients with BRG experience symptomatic manifestations and complications without progressing to neoplastic transformation.
The influence of other etiological factors on gastric neoplasia cannot be disregarded: Factors such as Helicobacter pylori infection, dietary habits, and lifestyle choices also play a significant role in the development of gastric neoplasia. While BRG may represent an elevated risk factor for the development of gastric neoplasia, the implementation of regular clinical follow-up and endoscopic surveillance is crucial for the early detection and management of potential complications [34].
3.11. BRG: A Risk Factor for Bile Reflux Esophagitis and Potential
Oesophageal Complications
Bile Reflux Gastritis (BRG) is not only a gastrointestinal concern but also a potential precursor to more serious oesophageal conditions. One significant complication of BRG is Bile Reflux Esophagitis (BRE). When bile acids reflux into the oesophagus, they can irritate the delicate lining, leading to inflammation, ulceration, and, in severe cases, Barrett’s oesophagus, a precancerous condition. Recent studies like Iwaya et al. (2023) [35] found a strong correlation between bile reflux gastropathy and functional dyspepsia, indicating that bile reflux can contribute to a range of upper gastrointestinal symptoms. Also, Lake et al. (2023) [36] demonstrated a clear association between endoscopic evidence of bile reflux and Barrett’s oesophagus, highlighting the potential role of bile reflux in the development of oesophageal complications.
Additionally, Monaco et al. emphasized the importance of considering bile reflux as a contributing factor to GERD symptoms, especially in patients who are not adequately controlled with PPIs [37]. The pathophysiological mechanisms underlying BRG are complex and multifaceted. Bile acid-induced mucosal injury, as evidenced by histological findings of gastritis and inflammation, is a central feature of the condition. The role of Helicobacter pylori in exacerbating BRG remains controversial, while the growing body of evidence on the gut microbiome’s influence on gastrointestinal diseases warrants further investigation into its potential role in BRG pathogenesis [38].
The clinical presentation of BRG is often nonspecific, making diagnosis challenging. While endoscopic findings can provide valuable clues, the lack of sensitive and specific diagnostic markers remains a limitation. Management strategies for BRG primarily focus on symptom relief and reducing bile reflux. Medical therapies, such as proton pump inhibitors and prokinetic agents, offer some benefit, their efficacy is often limited. Surgical interventions, including Roux-en-Y gastric bypass and pyloroplasty, have been explored for refractory cases. However, the optimal treatment approach for BRG requires further investigation [39].
The long-term consequences of BRG, including its potential association with gastric cancer, warrant further study. While the findings of Li et al. linking bile reflux to intestinal metaplasia raise concerns about the development of malignancy, additional research is necessary to establish a definitive causal relationship [40].
Present review highlights the complex nature of bile reflux gastritis and the need for further research to elucidate its epidemiology, pathophysiology, and optimal management strategies. By addressing these knowledge gaps, we can improve our understanding of BRG and develop more effective prevention and treatment approaches for this challenging condition.
3.12. Lifestyle and Dietary Modifications for Managing BRG
Symptoms
Lifestyle and dietary modifications play a crucial role in managing Bile Reflux Gastritis (BRG) symptoms. Dietary recommendations include reducing or avoiding foods that stimulate bile production or relax the lower esophageal sphincter, such as fatty foods, fried foods, chocolate, caffeine, alcohol, carbonated beverages, spicy foods, citrus fruits, tomato products, and peppermint. Increasing the intake of lean protein, fruits, vegetables, and whole grains is also beneficial. Consuming smaller, more frequent meals throughout the day can help minimize pressure on the lower esophageal sphincter [41].
Lifestyle modifications also contribute significantly to symptom management. Maintaining a healthy weight or losing excess weight can significantly improve BRG symptoms. Avoiding lying down for at least two to three hours after eating and elevating the head of the bed by 6 - 8 inches can help prevent nighttime reflux. Stress management techniques such as relaxation exercises, yoga, and mindfulness can also be beneficial as stress can exacerbate gastrointestinal symptoms [42].
Adherence to these lifestyle and dietary modifications can lead to a significant reduction in BRG symptoms, such as epigastric pain, nausea, and vomiting. However, the degree of improvement may vary among individuals.
Expected Outcomes:
Adherence to these lifestyle and dietary modifications can lead to a significant reduction in BRG symptoms, such as epigastric pain, nausea, and vomiting. However, the degree of improvement may vary among individuals.
4. Future Research Directions
The present review highlights several areas where further research is warranted to advance our understanding of bile reflux gastritis (BRG) and improve patient outcomes.
Epidemiology and Pathophysiology
Standardized Diagnostic Criteria: Develop clear and reproducible diagnostic criteria for BRG to facilitate accurate prevalence estimation and epidemiological studies.
Large-Scale Epidemiological Studies: Conduct population-based studies to determine the true prevalence of BRG and identify associated risk factors.
Gut Microbiome Characterization: Investigate the composition and function of the gut microbiome in patients with BRG to elucidate its role in disease pathogenesis.
Mechanisms of Bile Acid-Induced Injury: Explore the specific molecular mechanisms by which bile acids induce mucosal damage and inflammation.
Diagnostic Modalities
Non-Invasive Biomarkers: Identify novel biomarkers for BRG that can be readily assessed in clinical practice.
Imaging Techniques: Evaluate the potential of advanced imaging modalities, such as magnetic resonance imaging (MRI) and positron emission tomography (PET), for diagnosing and characterizing BRG.
Therapeutic Interventions
Novel Therapeutic Targets: Identify and validate molecular targets for drug development to address the underlying pathophysiology of BRG.
Efficacy and Safety of New Therapies: Conduct randomized controlled trials to evaluate the efficacy and safety of novel therapeutic agents, including those targeting the gut microbiome or bile acid metabolism.
Personalized Medicine: Develop predictive models to identify patients who may benefit most from specific treatment approaches.
Integrative Medicine: Explore the potential benefits of combining conventional and complementary therapies for managing BRG symptoms.
Long-Term Outcomes
Natural History Studies: Conduct longitudinal studies to characterize the natural history of BRG and identify factors associated with disease progression.
Quality of Life Assessment: Develop and validate patient-reported outcome measures to assess the impact of BRG on quality of life.
Cost-Effectiveness Analysis: Evaluate the cost-effectiveness of different treatment strategies for BRG.
By addressing these research priorities, we can significantly enhance our understanding of BRG and develop more effective prevention and treatment strategies for this challenging condition.
5. Limitations
This narrative review, while providing a comprehensive overview of bile reflux gastritis (BRG), is subject to certain limitations. Firstly, the reliance on published literature introduces potential biases, as studies with positive findings may be more likely to be reported. Additionally, the heterogeneity of study designs, patient populations, and outcome measures limits the ability to draw definitive conclusions.
The absence of standardized diagnostic criteria for BRG poses a significant challenge in accurately assessing prevalence and comparing study results. Moreover, the focus on human studies precludes the extrapolation of findings to animal models, which could provide valuable insights into disease pathogenesis.
The narrative review format, while allowing for a comprehensive exploration of the topic, does not employ quantitative methods such as meta-analysis to pool data and assess the overall strength of evidence. Furthermore, the review is limited to the information available at the time of the search, and new findings may emerge since its completion.
Acknowledging these limitations is crucial for interpreting the results of this review and guiding future research directions.
6. Conclusion
BRG represents a complex and often underdiagnosed gastrointestinal condition. While significant progress has been made in understanding its pathophysiology and clinical manifestations. By addressing the knowledge gaps identified in this review, we can improve the management of BRG and enhance the quality of life for affected individuals. Ongoing research is needed to develop more effective treatment strategies and improve long-term prognosis for patients with Bile reflux gastritis (BRG).
List of Abbreviations
BRG: Bile Reflux Gastritis
LES: Lower Oesophageal Sphincter
MRI: Magnetic Resonance Imaging
PET: Positron Emission Tomography
PPIs: Proton Pump Inhibitors