Duodenogastric Gadoxetic Acid Reflux on Routine Liver Magnetic Resonance Imaging and Upper Endoscopy Findings

Kul, Melahat; Kuru Oz, Digdem; AVCI, ORHAN; Erden, Ayşe

doi:10.4274/atfm.galenos.2023.80958

Duodenogastric Gadoxetic Acid Reflux on Routine Liver Magnetic Resonance Imaging and Upper Endoscopy Findings

Melahat KUL, (Ankara Üniversitesi, Tıp Fakültesi, Radyoloji Anabilim Dalı, Ankara, Türkiye)

Diğdem KURU ÖZ, (Ankara Üniversitesi, Tıp Fakültesi, Radyoloji Anabilim Dalı, Ankara, Türkiye)

Orhan AVCI, (Zonguldak Atatürk Devlet Hastanesi, Radyoloji ve Görüntüleme Kliniği, Zonguldak, Türkiye)

Ayşe ERDEN (Ankara Üniversitesi, Tıp Fakültesi, Radyoloji Anabilim Dalı, Ankara, Türkiye)

Ankara Üniversitesi Tıp Fakültesi Mecmuası

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Yıl: 2023 Cilt: 76 Sayı: 1 Sayfa Aralığı: 37 - 44 Metin Dili: İngilizce DOI: 10.4274/atfm.galenos.2023.80958 İndeks Tarihi: 17-07-2023

Duodenogastric Gadoxetic Acid Reflux on Routine Liver Magnetic Resonance Imaging and Upper Endoscopy Findings

Öz:

Objectives: Bile reflux gastritis is an underdiagnosed but common type of chemical gastritis (CG) caused by bile induced irritation of gastric mucosa. Diagnosis is based on endoscopic and histologic findings. However, if bile reflux is not observed, diagnosis of bile gastritis might be challenging. We aimed to evaluate duodenogastric gadoxetic acid (GA) reflux in routine liver magnetic resonance imaging (MRI) and to compare this finding with bile reflux and gastritis findings in upper endoscopy. Materials and Methods: A total of consecutive 45 patients who underwent GA-enhanced liver MRI with at least one delayed phase image (≥40 minutes delay) and upper endoscopy were retrospectively included. Images were reviewed by two radiologists regarding the presence and extent of gastric GA. Endoscopic and histologic results were noted. Results: Duodenogastric GA reflux was detected in 8 patients (17.8%). In 2 of them endoscopy revealed bile reflux. In one of these two patients gastritis was also noted,whereas gastric mucosa was considered as normal in the other patient. In 6 out of 8 patients with contrast reflux gastric bile stain was not reported. In each of these 6 patients erosive/erythematous gastritis was detected. Histopathology confirmed CG in 4 out of them. Conclusion: It might be challenging to differentiate bile induced gastritits from other types of CG, in particular, if gastric bile stain is not observed during upper endoscopy. Thus, radiologists should be aware of duodenogastric GA reflux on delayed phase MRI and report this finding. We suggest, that diagnostic performance of MRI regarding bile reflux and bile gastritis should be investigated with a multidisciplinary prospective study design.

Anahtar Kelime:

Rutin Karaciğer MR Görüntülemede Duodenogastrik Gadoksetik Asit Reflüsü ve Üst Gastrointestinal Sistem Endoskopisi Bulguları

Öz:

Amaç: Safra gastriti, yaygın bir kimyasal gastrit (KG) türü olup gastrik mukozanın safra kaynaklı hasarı ile ortaya çıkmaktadır. Tanı endoskopik ve histolojik bulgulara dayanmakla birlikte safra reflüsünün saptanmadığı durumlarda safra gastritini belirlemek zor olabilmektedir. Çalışmamızda, rutin karaciğer manyetik rezonans (MR) görüntülemede duodenogastrik gadoksetik asit (GA) reflüsünü değerlendirmeyi ve bu bulguyu üst endoskopide saptanan safra reflüsü ve gastrit bulguları ile karşılaştırmayı amaçladık. Gereç ve Yöntem: Temmuz 2011-Mayıs 2021 tarihleri arasında GA ile gerçekleştirilen toplam 1543 rutin dinamik karaciğer MR inceleme retrospektif olarak tarandı. Safra kanallarında kontrast maddenin izlendiği, en az bir geç faz (≥40 dakika) MR görüntüsü bulunan ve MR çekimi ile üst GİS endoskopi arasında 1 yıldan az süre olan 45 hasta çalışmaya dahil edildi. MR görüntüleri, kontrast madde reflüsü varlığı ve uzanımı açısından iki radyolog tarafından konsensus ile değerlendirildi. Hastaların endoskopik ve histopatolojik bulguları hastane kayıt sisteminden not edildi. Bulgular: Kırk beş hastanın 8’inde (%17,8) duodenogastrik GA reflü saptandı. Duodenogastrik GA reflü saptanan 8 hastanın 2’sinde endoskopide safra reflüsü mevcuttu. Endoskopik olarak da safra reflüsü kanıtlanan 2 hastanın birinde gastrit mevcutken, diğer hastada mide mukozası normal olarak değerlendirilmişti. Kontrast reflüsü olan 8 hastanın 6’sında endoskopik olarak midede safra rapor edilmemişti. Bu hastaların hepsinde (N=6) eroziv/eritemli gastrit ve 4’ünde histopatolojik olarak kanıtlanmış KG mevcuttu. Sonuç: Endoskopi sırasında midede safra gözlenmediği durumlarda safra kaynaklı gastritleri, diğer KG tiplerinden ayırt etmek güçtür. Duodenogastrik GA reflünün safra gastritinin göstergesi olabileceği radyologlar tarafından az bilinen bir durumdur. Klinik olarak da diğer KG tiplerinden ayırt edilmesi zor olabilen bu durumun, geç faz MRG’de saptanabileceğine dair farkındalığının artması gerekmektedir. Ön çalışma olan bulgularımızın, MRG’nin safra reflüsü ve gastritinde tanısal performansının ve klinik katkısının değerlendirileceği, multidisipliner prospektif çalışmalar ile destekleneceğine inanmaktayız.

Anahtar Kelime:

Belge Türü: Makale Makale Türü: Araştırma Makalesi Erişim Türü: Erişime Açık

1. Lake A, Rao SSC, Larion S, et al. Bile Reflux Gastropathy and Functional Dyspepsia. J Neurogastroenterol Motil. 2021;27:400-407.
2. Rhodes J, Bernando DE, Phillips SF, Revalstad A, Hoffman AF. Increased reflux of bile into the stomach in patients with gastric ulcer. Gastroenterol. 1969;57:241-251.
3. Tollin RD, Malmud LS, Stelzer F, et al. Enterogastric reflux in normal subjects and patients with Billroth II gastroenterostomy. Measurement of enterogastric reflux. Gastroenterol. 1979;77:1027-1033.
4. Bechi P, Amorosi A, Mazzanti R, Romagnoli P, Tonelli L. Gastric histology and fasting bile reflux after partial gastrectomy. Gastroenterology. 1987;93:335- 343.
5. Mercan E, Duman U, Tihan D, et al. Cholecystectomy and duodenogastric reflux: interacting effects over the gastric mucosa. Springerplus. 2016;5:1970.
6. Stein HJ, Feussner H, Kauer W, et al. Alkaline gastroesophageal reflux: assessment by ambulatory esophageal aspiration and pH monitoring. Am J Surg. 1994;167:163-168.
7. Chen TF, Yadav PK, Wu RJ, et al. Comparative evaluation of intragastric bile acids and hepatobiliary scintigraphy in the diagnosis of duodenogastric reflux. World J Gastroenterol. 2013;19:2187-2196.
8. Li D, Zhang J, Yao WZ, et al. The relationship between gastric cancer, its precancerous lesions and bile reflux: A retrospective study. J Dig Dis. 2020;21:222-229.
9. Zhao A, Wang S, Chen W, et al. Increased levels of conjugated bile acids are associated with human bile reflux gastritis. Sci Rep. 2020;10:11601.
10. Dixon MF, Genta RM, Yardley JH, et al. Classification and grading of gastritis. The updated Sydney System. International Workshop on the Histopathology of Gastritis, Houston 1994. Am J Surg Pathol. 1996;20:1161-1181.
11. Stein HJ, Smyrk TC, DeMeester TR, et al. Clinical value of endoscopy and histology in the diagnosis of duodenogastric reflux disease. Surgery. 1992;112:796-803.
12. Deng S, Cao Y, Shen L, et al. Bile reflux gastritis cystica profunda: A case report and literature review. Medicine (Baltimore). 2019;98:e15295.
13. Lee NK, Kim S, Lee JW, et al. Biliary MR imaging with Gd-EOB-DTPA and its clinical applications. Radiographics. 2009;29:1707-1724.
14. Taha AS, Nakshabendi I, Lee FD, et al. Chemical gastritis and Helicobacter pylori related gastritis in patients receiving non-steroidal anti-inflammatory drugs: comparison and correlation with peptic ulceration. J Clin Pathol. 1992;45:135-139.
15. Sartori S, Nielsen I, Maestri A, et al. Acute gastroduodenal mucosal injury after cisplatin plus etoposide chemotherapy. Clinical and endoscopic study. Oncology. 1991;48:356-361.
16. Sobala GM, O’Connor HJ, Dewar EP, et al. Bile reflux and intestinal metaplasia in gastric mucosa. J Clin Pathol. 1993;46:235-240.
17. Matsuhisa T, Arakawa T, Watanabe T, et al. Relation between bile acid reflux into the stomach and the risk of atrophic gastritis and intestinal metaplasia: a multicenter study of 2283 cases. Dig Endosc. 2013;25:519-525.
18. Zhang LY, Zhang J, Li D, et al. Bile reflux is an independent risk factor for precancerous gastric lesions and gastric cancer: An observational crosssectional study. J Dig Dis. 2021;22:282-290.
19. Scarpa PJ, Cappell MS. Treatment with ursodeoxycholic acid of bile reflux gastritis after cholecystectomy. J Clin Gastroenterol. 1991;13:601-603.
20. McCabe ME 4th, Dilly CK. New Causes for the Old Problem of Bile Reflux Gastritis. Clin Gastroenterol Hepatol. 2018;16:1389-1392.
21. Madura JA. Primary bile reflux gastritis: diagnosis and surgical treatment. Am J Surg. 2003;186:269-273.
22. Hyun JJ, Yeom SK, Shim E, et al. Correlation Between Bile Reflux Gastritis and Biliary Excreted Contrast Media in the Stomach. J Comput Assist Tomogr. 2017;41:696-701.
23. Radev D, Kotsev I, Panaiotov P, et al. [The incidence of duodenogastric reflux and its relation to stomach and duodenal diseases]. Khirurgiia (Sofiia). 1990;43:61-64.
24. Uyanikoglu A, Akyuz F, Ermis F, et al. Does Cholecystectomy Increase the Esophageal Alkaline Reflux? Evaluation by Impedance-pH Technique. J Neurogastroenterol Motil. 2012;18:187-193.
25. Verne GN, Soldevia-Pico C, Robinson ME, Spicer KM, Reuben A. Autonomic dysfunction and gastroparesis in cirrhosis. J Clin Gastroenterol. 2004;38:72- 76.

APA	Kul M, Kuru Oz D, AVCI O, Erden A (2023). Duodenogastric Gadoxetic Acid Reflux on Routine Liver Magnetic Resonance Imaging and Upper Endoscopy Findings. , 37 - 44. 10.4274/atfm.galenos.2023.80958
Chicago	Kul Melahat,Kuru Oz Digdem,AVCI ORHAN,Erden Ayşe Duodenogastric Gadoxetic Acid Reflux on Routine Liver Magnetic Resonance Imaging and Upper Endoscopy Findings. (2023): 37 - 44. 10.4274/atfm.galenos.2023.80958
MLA	Kul Melahat,Kuru Oz Digdem,AVCI ORHAN,Erden Ayşe Duodenogastric Gadoxetic Acid Reflux on Routine Liver Magnetic Resonance Imaging and Upper Endoscopy Findings. , 2023, ss.37 - 44. 10.4274/atfm.galenos.2023.80958
AMA	Kul M,Kuru Oz D,AVCI O,Erden A Duodenogastric Gadoxetic Acid Reflux on Routine Liver Magnetic Resonance Imaging and Upper Endoscopy Findings. . 2023; 37 - 44. 10.4274/atfm.galenos.2023.80958
Vancouver	Kul M,Kuru Oz D,AVCI O,Erden A Duodenogastric Gadoxetic Acid Reflux on Routine Liver Magnetic Resonance Imaging and Upper Endoscopy Findings. . 2023; 37 - 44. 10.4274/atfm.galenos.2023.80958
IEEE	Kul M,Kuru Oz D,AVCI O,Erden A "Duodenogastric Gadoxetic Acid Reflux on Routine Liver Magnetic Resonance Imaging and Upper Endoscopy Findings." , ss.37 - 44, 2023. 10.4274/atfm.galenos.2023.80958
ISNAD	Kul, Melahat vd. "Duodenogastric Gadoxetic Acid Reflux on Routine Liver Magnetic Resonance Imaging and Upper Endoscopy Findings". (2023), 37-44. https://doi.org/10.4274/atfm.galenos.2023.80958

APA	Kul M, Kuru Oz D, AVCI O, Erden A (2023). Duodenogastric Gadoxetic Acid Reflux on Routine Liver Magnetic Resonance Imaging and Upper Endoscopy Findings. Ankara Üniversitesi Tıp Fakültesi Mecmuası, 76(1), 37 - 44. 10.4274/atfm.galenos.2023.80958
Chicago	Kul Melahat,Kuru Oz Digdem,AVCI ORHAN,Erden Ayşe Duodenogastric Gadoxetic Acid Reflux on Routine Liver Magnetic Resonance Imaging and Upper Endoscopy Findings. Ankara Üniversitesi Tıp Fakültesi Mecmuası 76, no.1 (2023): 37 - 44. 10.4274/atfm.galenos.2023.80958
MLA	Kul Melahat,Kuru Oz Digdem,AVCI ORHAN,Erden Ayşe Duodenogastric Gadoxetic Acid Reflux on Routine Liver Magnetic Resonance Imaging and Upper Endoscopy Findings. Ankara Üniversitesi Tıp Fakültesi Mecmuası, vol.76, no.1, 2023, ss.37 - 44. 10.4274/atfm.galenos.2023.80958
AMA	Kul M,Kuru Oz D,AVCI O,Erden A Duodenogastric Gadoxetic Acid Reflux on Routine Liver Magnetic Resonance Imaging and Upper Endoscopy Findings. Ankara Üniversitesi Tıp Fakültesi Mecmuası. 2023; 76(1): 37 - 44. 10.4274/atfm.galenos.2023.80958
Vancouver	Kul M,Kuru Oz D,AVCI O,Erden A Duodenogastric Gadoxetic Acid Reflux on Routine Liver Magnetic Resonance Imaging and Upper Endoscopy Findings. Ankara Üniversitesi Tıp Fakültesi Mecmuası. 2023; 76(1): 37 - 44. 10.4274/atfm.galenos.2023.80958
IEEE	Kul M,Kuru Oz D,AVCI O,Erden A "Duodenogastric Gadoxetic Acid Reflux on Routine Liver Magnetic Resonance Imaging and Upper Endoscopy Findings." Ankara Üniversitesi Tıp Fakültesi Mecmuası, 76, ss.37 - 44, 2023. 10.4274/atfm.galenos.2023.80958
ISNAD	Kul, Melahat vd. "Duodenogastric Gadoxetic Acid Reflux on Routine Liver Magnetic Resonance Imaging and Upper Endoscopy Findings". Ankara Üniversitesi Tıp Fakültesi Mecmuası 76/1 (2023), 37-44. https://doi.org/10.4274/atfm.galenos.2023.80958