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Duodeno-gastric-esophageal reflux--what is pathologic? Comparison of patients with Barrett's esophagus and age-matched volunteers.
J Gastrointest Surg. 2007 Apr; 11(4):479-86.JG

Abstract

INTRODUCTION

The aim of the study was to analyse pH- and bile-monitoring data in patients with Barrett's esophagus and in age- and gender-matched controls.

SUBJECTS AND METHODS

Twenty-four consecutive Barrett's patients (8 females, 16 males, mean age 57 years), 21 patients with esophagitis (10 females, 11 males, mean age 58 years), and 19 healthy controls (8 females, 11 males, mean age 51 years), were included. Only patients underwent endoscopy with biopsy. All groups were investigated with manometry, gastric and esophageal 24-h pH, and simultaneous bile monitoring according to a standardized protocol. A bilirubin absorption>0.25 was determined as noxious bile reflux. The receiver operator characteristic (ROC) method was applied to determine the optimal cutoff value of pathologic bilirubin levels.

RESULTS

Of Barrett's patients, 79% had pathologic acidic gastric reflux (pH<4>5% of total measuring time). However, 32% of healthy controls also had acid reflux (p<0.05) without any symptoms. The median of esophageal bile reflux was 7.8% (lower quartile (LQ)-upper quartile (UQ)=1.6-17.8%) in Barrett's patients, in patients with esophagitis, 3.5% (LQ-UQ=0.1-13.5), and in contrast to 0% (LQ-UQ=0-1.0%) in controls, p=0.001. ROC analysis showed the optimal dividing value for patients at more than 1% bile reflux over 24 h (75% sensitivity, 84% specificity).

CONCLUSION

An optimal threshold to differentiate between normal and pathological bile reflux into the esophagus is 1% (24-h bile monitoring with an absorbance>0.25).

Authors+Show Affiliations

Department of Visceral and Vascular Surgery, University of Cologne, Cologne, Germany.No affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

17436133

Citation

Wolfgarten, Eva, et al. "Duodeno-gastric-esophageal Reflux--what Is Pathologic? Comparison of Patients With Barrett's Esophagus and Age-matched Volunteers." Journal of Gastrointestinal Surgery : Official Journal of the Society for Surgery of the Alimentary Tract, vol. 11, no. 4, 2007, pp. 479-86.
Wolfgarten E, Pütz B, Hölscher AH, et al. Duodeno-gastric-esophageal reflux--what is pathologic? Comparison of patients with Barrett's esophagus and age-matched volunteers. J Gastrointest Surg. 2007;11(4):479-86.
Wolfgarten, E., Pütz, B., Hölscher, A. H., & Bollschweiler, E. (2007). Duodeno-gastric-esophageal reflux--what is pathologic? Comparison of patients with Barrett's esophagus and age-matched volunteers. Journal of Gastrointestinal Surgery : Official Journal of the Society for Surgery of the Alimentary Tract, 11(4), 479-86.
Wolfgarten E, et al. Duodeno-gastric-esophageal Reflux--what Is Pathologic? Comparison of Patients With Barrett's Esophagus and Age-matched Volunteers. J Gastrointest Surg. 2007;11(4):479-86. PubMed PMID: 17436133.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Duodeno-gastric-esophageal reflux--what is pathologic? Comparison of patients with Barrett's esophagus and age-matched volunteers. AU - Wolfgarten,Eva, AU - Pütz,Benito, AU - Hölscher,Arnulf H, AU - Bollschweiler,Elfriede, PY - 2007/4/17/pubmed PY - 2007/9/5/medline PY - 2007/4/17/entrez SP - 479 EP - 86 JF - Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract JO - J. Gastrointest. Surg. VL - 11 IS - 4 N2 - INTRODUCTION: The aim of the study was to analyse pH- and bile-monitoring data in patients with Barrett's esophagus and in age- and gender-matched controls. SUBJECTS AND METHODS: Twenty-four consecutive Barrett's patients (8 females, 16 males, mean age 57 years), 21 patients with esophagitis (10 females, 11 males, mean age 58 years), and 19 healthy controls (8 females, 11 males, mean age 51 years), were included. Only patients underwent endoscopy with biopsy. All groups were investigated with manometry, gastric and esophageal 24-h pH, and simultaneous bile monitoring according to a standardized protocol. A bilirubin absorption>0.25 was determined as noxious bile reflux. The receiver operator characteristic (ROC) method was applied to determine the optimal cutoff value of pathologic bilirubin levels. RESULTS: Of Barrett's patients, 79% had pathologic acidic gastric reflux (pH<4>5% of total measuring time). However, 32% of healthy controls also had acid reflux (p<0.05) without any symptoms. The median of esophageal bile reflux was 7.8% (lower quartile (LQ)-upper quartile (UQ)=1.6-17.8%) in Barrett's patients, in patients with esophagitis, 3.5% (LQ-UQ=0.1-13.5), and in contrast to 0% (LQ-UQ=0-1.0%) in controls, p=0.001. ROC analysis showed the optimal dividing value for patients at more than 1% bile reflux over 24 h (75% sensitivity, 84% specificity). CONCLUSION: An optimal threshold to differentiate between normal and pathological bile reflux into the esophagus is 1% (24-h bile monitoring with an absorbance>0.25). SN - 1091-255X UR - https://www.unboundmedicine.com/medline/citation/17436133/Duodeno_gastric_esophageal_reflux__what_is_pathologic_Comparison_of_patients_with_Barrett's_esophagus_and_age_matched_volunteers_ L2 - https://dx.doi.org/10.1007/s11605-006-0017-7 DB - PRIME DP - Unbound Medicine ER -