Assesment of the clinical usability of magnetic resonance imaging with gadoxetic acid in the diagnosis of alkaline reflux gastritis

Alkaline reflux gastritis is the damage to the gastric mucosa as a result of the reflux of bile and pancreatic secretions from the duodenum into the stomach. Clinically, it is difficult to diagnose due to the absence of specific symptoms. For a definitive diagnosis, endoscopic findings of mucosal erythema, the presence of bile and bile salts in the stomach, and histopathological evaluation are necessary. Treatment options range from lifestyle modifications and medication to surgical interventions. Gadoxetic acid (gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid) is a liver-specific magnetic resonance (MR) contrast agent. Up to 50% of the administered dose is taken up by functional hepatocytes and subsequently excreted into the bile ducts. In clinical practice, it has been observed that contrast material excreted from the bile ducts is often seen in the gastric lumen during MR cholangiography (G-MRC) enhanced with gadoxetic acid. We hypothesized that this could represent duodenogastric bile reflux and that the presence of contrast material in the stomach during the late phase of MRC could be closely related to alkaline reflux gastritis. Patients from the General Surgery Department at Düzce University Faculty of Medicine were retrospectively analyzed. The study included 103 patients diagnosed with alkaline reflux gastritis through endoscopy and 103 control patients without alkaline reflux gastritis findings on endoscopy. In our study, the effectiveness of the G-MRC method in diagnosing alkaline reflux gastritis was evaluated, yielding statistically significant results with a sensitivity of 82.52% and a specificity of 74.76%, consistent with the literature. In conclusion, we believe that MRI can serve as a good alternative to current diagnostic methods for alkaline reflux gastritis, offering a non-invasive, radiation-free, high-resolution imaging modality with a wide field of view and extended duration.