Bile reflux is an independent risk factor for precancerous gastric lesions and gastric cancer: An observational cross-sectional study

J Dig Dis. 2021 May;22(5):282-290. doi: 10.1111/1751-2980.12986. Epub 2021 May 6.


Objective: To identify whether bile reflux on endoscopy and other related variables are risk factors for precancerous gastric lesions and gastric cancer (GC).

Methods: A multicenter, cross-sectional and observational study was conducted in five centers in China from June to October 2019, 1162 patients were recruited and divided into the chronic gastritis (CG), the precancerous lesion (low-grade intraepithelial neoplasia and intestinal metaplasia), and GC groups (including high-grade intraepithelial neoplasia). All participants underwent detailed interviews, endoscopy and biopsy, and completed questionnaires. Odds ratio and 95% confidence interval were calculated with multivariate logistic regression models with or without adjustment for Helicobacter pylori infection.

Results: We recruited 668 patients with CG, 411 with precancerous lesions and 83 with GC. By comparing the CG and precancerous lesion groups, independent risk factors for cancerous gastric lesions were the grade of bile reflux, patient's age, dietary habits and family history of GC. Similar results were obtained when comparing the CG and GC groups. In addition, bile reflux was confirmed as an independent risk factor for progression from precancerous lesions to cancer.

Conclusions: Bile reflux on endoscopy as well as age, dietary habits and a family history of GC were independent risk factors for the development of precancerous gastric lesions and GC.

Keywords: bile reflux; gastric neoplasms; intestinal metaplasia; precancerous lesion.

Publication types

  • Multicenter Study
  • Observational Study

MeSH terms

  • Bile Reflux*
  • China / epidemiology
  • Cross-Sectional Studies
  • Female
  • Gastric Mucosa
  • Helicobacter Infections* / complications
  • Helicobacter pylori*
  • Humans
  • Male
  • Metaplasia
  • Precancerous Conditions*
  • Risk Factors
  • Stomach Neoplasms* / epidemiology
  • Stomach Neoplasms* / etiology