Pathogenic and therapeutic role of bile acids at reflux-gastritis

Abstract

The aim of review. To present data on pathogenic significance of bile acids for upper regions of gastrointestinal tract (GIT) and to describe medical properties ursodeoxycholic acid (UDCA) at reflux-gastritis.Summary. Reflux-gastritis is chemical type gastritis, morphologically manifested by foveolar hyperplasia, edema, proliferation of smooth-muscle fibres of lamina propria, insignificant chronic inflammation. There is evidences of relation of intestinal metaplasia to duodenogastric reflux (DGR). Bile acids at certain conditions possess damage effect on mucosa of the stomach and all GIT. They can increase endocellular concentration of calcium which is responsible for toxic effects of bile acids as a secondary messenger. Increase of endocellular calcium stimulates secretion of pepsinogen and acid production in the stomach, that in the case of decreased cytoprotective factors by DGR can cause changes mucosal injury. According to the modern point of view bile acids are associated with a lot of neoplasms of digestive organs, including esophageal, stomach, small intestine, liver, pancreas and colorectal cancer. Exposition of bile acids results in formation of active forms of oxygen and nitrogen, damage of DNA, mutagenicity, induction of apoptosis in short-term prospect and resistance to apoptosis in long-term prospect. Gastric remnant gastritis is consideres to be a premalignant disease, thus bile acids play essential role in carcinogenesis. UDCA possesses choleretic effect and ability to displace toxic hydrophobic bile acids. It protects from oxydative stress, stabilizes cell membranes and inhibits apoptosis. At reflux-gastritis UDCA relieves clinical symptoms, improves of state of mucosa of the stomach and esophagus, and possess series of cytoprotective properties.Conclusion. Prescription of UDCA is pathogenicly proved in patients with reflux-gastritis and gastroesopha geal reflux disease (GERD) with non-acidic refluxes. Cytoprotective and antiapoptotic effects of UDCA at reflux-gastritis are especially significant from the point of view of smoothing cancerogenic potential of bile acids.

Keywords

• reflux-gastritis
• gerd
• ursodeoxycholic acid
• bile acids
• duodenogastric reflux