Managing Chronic Non-Atrophic Gastritis with Bile Reflux

Chronic non-atrophic gastritis, also known as superficial gastritis, is a common type of chronic gastritis characterized by inflammation of the gastric mucosa caused by various factors. When this condition is accompanied by bile reflux, it typically results from dysfunction of the pyloric sphincter, allowing bile-containing duodenal contents to flow back into the stomach. This reflux can cause inflammation, erosion, and bleeding of the gastric mucosa, weaken the mucosal barrier, and increase hydrogen ion diffusion, ultimately leading to chronic gastric lesions.

During endoscopic examination, signs of bile reflux may include a large amount of light yellow to greenish fluid in the gastric cavity, excessive bile-containing mucus adhering to the gastric wall, or visible yellowish foamy or flowing bile refluxing from the pylorus. In addition, the pylorus may appear relaxed or remain in an open state. Gastritis-related changes such as diffuse redness of the gastric mucosa, edematous mucosal folds, and possible erosion or ulcers may also be observed.

Lifestyle and Dietary Adjustments Are Crucial
Patient education plays a vital role in managing this condition. A balanced and diverse diet is recommended, while moldy foods should be strictly avoided. It's important to reduce consumption of smoked, pickled, or nitrate-rich foods and instead opt for fresh, nutrient-dense options. Spicy, coarse, or heavily seasoned foods, along with long-term excessive alcohol consumption, should be avoided. Smoking cessation is also essential. Maintaining a positive mental state and ensuring adequate sleep can further support digestive health.

Medication Options Offer Symptom Relief and Healing
Several drug therapies are available to address different aspects of the condition:

1. Prokinetic Agents: These medications enhance gastrointestinal motility and help prevent bile from flowing back into the stomach while promoting the clearance of refluxed material. Commonly prescribed options include domperidone and mosapride.

2. Mucosal Protective Agents: These drugs form a protective layer over the gastric mucosa by binding with mucoproteins, reducing irritation from bile and acid, and supporting mucosal regeneration and healing.

3. Bile Acid Binders:
- Hydrotalcite: This compound binds to bile acids and lysophosphatidylcholine, thereby reducing mucosal damage caused by bile. It is widely used in clinical practice for bile reflux gastritis.
- Anion Exchange Resins (e.g., cholestyramine): These agents release chloride ions in the gut that bind to bile acids, forming insoluble complexes that are excreted in the feces, thus reducing mucosal injury.

4. Acid-Suppressing Medications: Since acid and bile have a synergistic damaging effect on the gastric lining, reducing acid levels is an effective strategy.
- H2 Receptor Antagonists (H2RAs): Examples include cimetidine, ranitidine, and famotidine.
- Proton Pump Inhibitors (PPIs): These are more potent and include omeprazole, lansoprazole, rabeprazole, pantoprazole, and esomeprazole. PPIs provide superior acid suppression compared to H2RAs.

5. Helicobacter pylori Eradication: In cases where H. pylori infection coexists with bile reflux gastritis, it should be treated promptly. Eradicating this bacterium not only promotes healing but also lowers the risk of gastric cancer development.

Early Diagnosis and Medical Guidance Are Essential
When symptoms of chronic non-atrophic gastritis arise, it's important to identify the underlying cause as early as possible. Seeking professional medical advice ensures timely and appropriate treatment, which can significantly improve outcomes and prevent complications.