胆汁反流对儿童胃黏膜损伤的内镜及病理特征研究

Endoscopic and pathological features of gastric mucosal injury caused by bile reflux in children

摘要:

目的 探讨胆汁反流对儿童胃黏膜损伤的影响及其内镜下表现和病理特征。方法 选取2019年1月－2025年8月于该院儿内科就诊的胆汁反流性胃炎（BRG）患儿93例（BRG组），选择同期93例非胆汁反流性胃炎（non-BRG）患儿作为对照（non-BRG组），比较两组患儿的临床表现、内镜下表现和病理特征。依据胃镜观察到的黏液湖黄色染色深浅程度，对BRG患儿实施反流程度分级评估，比较不同胆汁反流程度分级患儿的临床表现、内镜下表现和病理特征。结果 BRG组恶心、呕吐、反酸和烧心等临床症状，以及黏膜糜烂、出血点、黄染及胆汁斑等内镜表现的发生率明显高于non-BRG组，差异均有统计学意义（P < 0.05）。病理检查显示，BRG组间质水肿、固有层内平滑肌纤维增生及黏膜浅层血管扩张的发生率亦明显高于non-BRG组，而炎症活动性、幽门螺杆菌（Hp）感染及淋巴滤泡增生的发生率和中重度炎症占比明显低于non-BRG组，差异均有统计学意义（P < 0.05）。BRG不同胆汁反流分级患儿比较：Ⅰ级组、Ⅱ级组和Ⅲ级组腹胀等临床表现，充血、黄染和胆汁斑等内镜表现，以及炎症程度、黏膜浅层血管扩张、胃小凹增生等病理特征的发生率或严重程度比较，差异均有统计学意义（P < 0.05）。其中，Ⅰ级组腹胀、充血、黏膜浅层血管扩张和胃小凹增生的发生率明显低于Ⅲ级组，黄染、胆汁斑的发生率明显低于Ⅱ级组和Ⅲ级组，炎症程度明显轻于Ⅲ级组，差异均有统计学意义（P < 0.0167）。结论 儿童BRG相对于non-BRG，更容易引起恶心、呕吐、反酸和烧心等临床表现，且内镜下表现以黏膜糜烂、出血点、黄染和胆汁斑较为多见，病理特征以间质水肿、固有层内平滑肌纤维增生和黏膜浅层血管扩张较为多见，且腹胀、充血、黄染、胆汁斑、黏膜浅层血管扩张和胃小凹增生的发生与胆汁反流的严重程度有关。

Abstract:

Objective To investigate the effect of bile reflux on gastric mucosal injury in children and its endoscopic and pathological features.Methods Between January 2019 and August 2025, this investigation included 93 pediatric patients diagnosed with bile reflux gastritis (BRG) (BRG group) alongside 93 age-matched controls exhibiting non-bile reflux gastritis (non-bile reflux gastritis) (non-bile reflux gastritis group). Comprehensive evaluations were performed to analyze symptomatic presentations, endoscopic observations, and histopathological differences between both cohorts. The bile reflux cases were further stratified based on endoscopic grading of bile-stained mucosal appearances. Subsequent comparative analyses examined clinical symptoms, endoscopic patterns, and tissue-level characteristics across varying severity classifications.Results The incidence of clinical symptoms such as nausea and vomiting, acid regurgitation and heartburn, as well as endoscopic findings including mucosal erosion, bleeding spots, yellow staining, and bile spots in the BRG group were higher than those in the non-bile reflux gastritis group, the differences were statistically significant (P < 0.05); Pathological examination revealed that the incidence of interstitial edema, smooth muscle fiber hyperplasia in the lamina propria, and superficial mucosal vascular dilatation were significantly higher in the BRG group compared to the non-bile reflux gastritis group, active inflammation, Helicobacter pylori (Hp) infection, lymphoid follicular hyperplasia and the proportion of moderate to severe inflammation, were lower in the BRG group than those in the non-bile reflux gastritis group, and the differences were statistically significant (P < 0.05). Comparison between children with different grades of BRG: there were significant differences in the incidence or severity of clinical manifestations (abdominal bloating) and endoscopic manifestations (hyperemia, yellow staining, and bile spots), as well as pathological features (inflammation degree, superficial mucosal vascular dilatation, gastric foveolar hyperplasia) among the grade Ⅰ group, grade Ⅱ group and grade Ⅲ group (P < 0.05). The incidences of abdominal bloating, hyperemia, superficial mucosal vascular dilatation and gastric foveolar hyperplasia in grade Ⅰ group were significantly lower than those in grade Ⅲ group (P < 0.0167). The incidences of yellow staining and bile spots in the grade Ⅰ group were significantly lower than those in the grade Ⅱ group and the grade Ⅲ group (P < 0.0167). The inflammation degree in the grade Ⅰ group was significantly lower than that in the grade Ⅲ group (P < 0.0167).Conclusion Pediatric cases of BRG exhibit more pronounced symptoms including nausea, vomiting, acid regurgitation, and heartburn when contrasted with non-bile reflux gastritis. Endoscopic examinations frequently reveal mucosal erosions, hemorrhagic lesions, yellowish discoloration, and bile deposits. Histopathological analysis demonstrates characteristic findings such as interstitial edema, smooth muscle fiber hyperplasia in the lamina propria, and dilation of superficial mucosal vasculature. The intensity of bile reflux correlates with clinical manifestations such as abdominal bloating, mucosal hyperemia, yellow staining, bile spots, vascular dilation, and gastric foveolar hyperplasia.