Does duodenal juice reflux into the esophagus of patients with complicated GERD? evaluation of a fiberoptic sensor for bilirubin (original) (raw)

Gastric bilirubin monitoring to assess duodenogastric reflux

Digestive diseases and sciences, 2002

Duodenogastric reflux (DGR) was assessed with 24-hour gastric bilirubin monitoring in 345 patients (219 men; 49 +/- 13 years) with foregut symptoms and 41 healthy subjects (24 men, 28 +/- 5 years). Bilirubin exposure was measured as percent time above absorbance level 0.25 and excessive DGR was defined above the 95th percentile of normal values (>24.8%). DGR was highest following Billroth II gastric resection (60 +/- 24%, N = 15). Patients after cholecystectomy (28 +/- 25%, N = 25), patients with gastroesophageal reflux disease (24 +/- 24%, N = 199), and patients with nonulcer dyspepsia (23 +/- 21%, N = 61) had a significantly higher exposure to DGR than healthy subjects (7 +/- 8%, P < 0.0001). In conclusion, gastric bilirubin monitoring is useful for the assessment of DGR specifically in symptomatic patients following gastric resection. Increased amounts of DGR may further be of clinical importance in patients with reflux disease or nonulcer dyspepsia and following cholecyste...

Bile reflux measurement and its contribution to the severity of reflux esophagitis

Saudi Journal of Gastroenterology, 2007

Background/Aims: Gastroesophageal refl ux disease (GERD) may occur with acid, bile or in a mixed form. Endoscopic injury and mucosal metaplasia are a known sequelae to pathological GERD. The aim of the study was to determine the contribution of acid and duodenogastroesophageal refl ux to endoscopic severity in patients with GERD and Barrett's esophagus (BE). Materials and Methods: Ninety-one patients complaining of refl ux symptoms were studied with upper gastrointestinal endoscopy and graded to nonerosive refl ux disease (NERD), erosive refl ux disease (ERD) and BE. Esophageal manometry and simultaneous ambulatory 24-h esophageal pH and bilirubin monitoring (Bilitec 2000) were performed in all patients. Results: Seventy-one patients (78.0%) had ERD (Savary-Miller (grade I-III), 11 patients (12.1%) had NERD and 9 patients (9.9%) had BE, which were suspected endoscopically and diagnosed by histological esophageal biopsy. Combined 24-h esophageal bilirubin and pH monitoring revealed the following: 39 patients (42.9%) had mixed acid and bile refl ux, 16 (17.6%) had pathological acid refl ux alone, 18 (19.8%) had bile refl ux alone and 18 patients (19.8%) showed no evidences of abnormal refl ux. The percentage of the total time of the bilirubin absorbance > 0.14 in 71 patients with ERD was (8.18 ± 11.28%) and in 9 patients with BE was (15.48 ± 30.48%), which was signifi cantly greater than that in 11 patients with NERD (4.48 ± 8.99%), P < 0.05 and P = 0.01 respectively. All the BE patients had abnormal esophageal bile refl ux (bile alone (3 patients)); and mixed bile and acid (6 patients)); 44 of 71 patients (61.97%) with ERD had abnormal esophageal bile refl ux (alone (13 patients) and mixed bile and acid (31 patients)); meanwhile, 15 of them (21.2%) had abnormal acid exposure alone. Despite 11 patients having NERD, four patients (36.4%) had abnormal esophageal bile refl ux and two of them had mixed refl ux of bile with acid. Conclusion: We believe that the Bilitec method reliably identifi es the presence of bilirubin and quantitatively detects the duodenogastroesophageal refl ux of bile. Mixed refl ux (acid and bile) is the chief pattern of refl ux in our GERD patients. Bile refl ux either alone or along with acid refl ux contributes to the severity of erosive and nonerosive refl ux diseases as well as in BE.

Detection of bile reflux: in vivo validation of the Bilitec fibreoptic system

Diseases of the Esophagus, 2000

The Bilitec ambulatory bile re¯ux monitor is advocated for the assessment of bile re¯ux. However, it has only been validated by bench top (in vitro) studies. This in vivo study used controlled`iatrogenic' episodes of bile re¯ux to determine the ability of the Bilitec system to detect bile acids in the oesophageal lumen.

Duodenogastric reflux potentiates the injurious effects of gastroesophageal reflux

Journal of Gastrointestinal Surgery, 1997

Experimental studies have shown that the severity of esophageal mucosal injury in gastroesophageal reflux disease is related to the reflux of both gastric and duodenal juice. The purpose of this study was to determine whether duodenal juice potentiates esophageal injury in patients with reflux disease or, in fact, causes no harm allowing acid and pepsin to do the damage. A total of 148 consecutive patients who had no previous gastric or esophageal surgery underwent endoscopy and biopsy, manometry, and 24-hour esophageal pH and bilirubin monitoring.

Analysis of ambulatory duodenogastroesophageal reflux monitoring

Digestive diseases and sciences, 2000

Some methodological in vitro observations concerning bile reflux monitoring (Bilitec) suggested that Bilitec monitoring is underestimating reflux in an acid environment. Moreover, other studies showed that the area above the cutoff level of bilirubin absorbance would provide an adequate quantitative marker for reflux of duodenal contents. Our aim was to study whether correction for intraesophageal acidity and the area above cutoff during Bilitec monitoring affects the results and the correlation with pH measurement and esophageal lesions. In 84 patients (46 men; mean age 46 +/- 2.7 years) evaluated for suspected gastroesophageal reflux disease, we performed ambulatory 24-hr esophageal pH and Bilitec monitoring after an upper gastrointestinal endoscopy. We obtained total area, percent total time, and correction by computer software. The correction factor for bilirubin absorbance was based on literature data for acidified bile (0.06 for pH < 3.6; 0.21 for pH < 2.6). Endoscopy re...

Long-term ambulatory enterogastric reflux monitoring

Digestive Diseases and Sciences, 1993

A new technique for the long-term ambulatory detection of enterogastric and nonacid gastroesophageal reflux has been conceived, developed, and validated. It is based on the use of a fiberoptic sensor that utilizes the op~cal properties of bile. In vitro studies have shown good precision, good stability, sensitivity of 2. 5 lamol/liter bilirubin concentration, as well as a useful working range of 2. 5-100 lamol/liter bilirubin concentration. In vivo studies have been performed in 29 subjects. Simultaneous gastric aspirations have allowe d a comparison of fiberoptic system measurements both with spectrophotometric analYsis and bile acid concentrations of corresponding gastric juice samples. Linear correlations were shown between fiberoptic assessment and both spectrophotometric and bile acid Concentration fndings (P < O. 01). Simultaneous assessment of reflux with the fiberoptic system and cholescintigraphy has shown a 92. 9% concordance as regards the presence or absence of reflux. Present results imply that th e fiberoptic system is an important tool for the understanding of the clinical relevance of enterogastric and nonacid gastroesophageal reflux.