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Bile reflux measurement and its contribution to the severity of reflux esophagitis.
Saudi J Gastroenterol. 2007 Oct-Dec; 13(4):180-6.SJ

Abstract

BACKGROUND/AIMS

Gastroesophageal reflux 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 reflux to endoscopic severity in patients with GERD and Barrett's esophagus (BE).

MATERIALS AND METHODS

Ninety-one patients complaining of reflux symptoms were studied with upper gastrointestinal endoscopy and graded to nonerosive reflux disease (NERD), erosive reflux 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 reflux, 16 (17.6%) had pathological acid reflux alone, 18 (19.8%) had bile reflux alone and 18 patients (19.8%) showed no evidences of abnormal reflux. 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 significantly 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 reflux (bile alone (3 patients)); and mixed bile and acid (6 patients)); 44 of 71 patients (61.97%) with ERD had abnormal esophageal bile reflux (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 reflux and two of them had mixed reflux of bile with acid.

CONCLUSION

We believe that the Bilitec method reliably identifies the presence of bilirubin and quantitatively detects the duodenogastroesophageal reflux of bile. Mixed reflux (acid and bile) is the chief pattern of reflux in our GERD patients. Bile reflux either alone or along with acid reflux contributes to the severity of erosive and nonerosive reflux diseases as well as in BE.

Authors+Show Affiliations

Gastroenterology Surgical Center, Mansoura University, Mansoura, Egypt. gadelhak_n_eg@hotmail.comNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

19858643

Citation

GadEl-Hak, Nabil A., et al. "Bile Reflux Measurement and Its Contribution to the Severity of Reflux Esophagitis." Saudi Journal of Gastroenterology : Official Journal of the Saudi Gastroenterology Association, vol. 13, no. 4, 2007, pp. 180-6.
GadEl-Hak NA, El-Hemaly M, Hamdy E, et al. Bile reflux measurement and its contribution to the severity of reflux esophagitis. Saudi J Gastroenterol. 2007;13(4):180-6.
GadEl-Hak, N. A., El-Hemaly, M., Hamdy, E., AbdEl-Raouf, A., Mostafa, M., & Haleem, M. (2007). Bile reflux measurement and its contribution to the severity of reflux esophagitis. Saudi Journal of Gastroenterology : Official Journal of the Saudi Gastroenterology Association, 13(4), 180-6. https://doi.org/10.4103/1319-3767.36749
GadEl-Hak NA, et al. Bile Reflux Measurement and Its Contribution to the Severity of Reflux Esophagitis. Saudi J Gastroenterol. 2007 Oct-Dec;13(4):180-6. PubMed PMID: 19858643.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Bile reflux measurement and its contribution to the severity of reflux esophagitis. AU - GadEl-Hak,Nabil A, AU - El-Hemaly,Mohamed, AU - Hamdy,Emad, AU - AbdEl-Raouf,Ahmed, AU - Mostafa,Mohamed, AU - Haleem,Magdy, PY - 2009/10/28/entrez PY - 2007/10/1/pubmed PY - 2007/10/1/medline SP - 180 EP - 6 JF - Saudi journal of gastroenterology : official journal of the Saudi Gastroenterology Association JO - Saudi J Gastroenterol VL - 13 IS - 4 N2 - BACKGROUND/AIMS: Gastroesophageal reflux 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 reflux to endoscopic severity in patients with GERD and Barrett's esophagus (BE). MATERIALS AND METHODS: Ninety-one patients complaining of reflux symptoms were studied with upper gastrointestinal endoscopy and graded to nonerosive reflux disease (NERD), erosive reflux 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 reflux, 16 (17.6%) had pathological acid reflux alone, 18 (19.8%) had bile reflux alone and 18 patients (19.8%) showed no evidences of abnormal reflux. 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 significantly 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 reflux (bile alone (3 patients)); and mixed bile and acid (6 patients)); 44 of 71 patients (61.97%) with ERD had abnormal esophageal bile reflux (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 reflux and two of them had mixed reflux of bile with acid. CONCLUSION: We believe that the Bilitec method reliably identifies the presence of bilirubin and quantitatively detects the duodenogastroesophageal reflux of bile. Mixed reflux (acid and bile) is the chief pattern of reflux in our GERD patients. Bile reflux either alone or along with acid reflux contributes to the severity of erosive and nonerosive reflux diseases as well as in BE. SN - 1998-4049 UR - https://www.unboundmedicine.com/medline/citation/19858643/Bile_reflux_measurement_and_its_contribution_to_the_severity_of_reflux_esophagitis_ L2 - http://www.saudijgastro.com/article.asp?issn=1319-3767;year=2007;volume=13;issue=4;spage=180;epage=186;aulast=GadEl-Hak DB - PRIME DP - Unbound Medicine ER -
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