ACID, BILE, EITHER OR BOTH

January 29, 2010

here was the hint for me, treatment for acid reflux made it much,much worse.

2008 Mar-Apr;55(82-83):442-7.

Acid and bile reflux in erosive reflux disease, non-erosive reflux disease and

Barrett's esophagus.

Hak NG, Mostafa M, Salah T, El-Hemaly M, Haleem M, Abd El-Raouf A, Hamdy E.

Gastroenterology Surgical Center, Mansoura University, Mansoura, Egypt.

gadelhak_n_eg@...

BACKGROUND/AIMS: Gastroesophageal reflux disease (GERD) may occur with acid,

bile or in a mixed form. Endoscopic injury and mucosal metaplasia are a known

sequlae to pathological GERD. The aim of the study was to determine the

contribution of acid and duodenogastroesophageal reflux (DGER) to endoscopic

severity in patients with GERD and Barrett's esophagus. METHODS: Ninety-one

patients complaining of reflux symptoms were studied with upper gastrointestinal

endoscopy and graded to non-erosive reflux disease (NERD), erosive reflux

disease (ERD) and Barrett's esophagus (BE). Esophageal manometry and

simultaneous ambulatory 24-h esophageal pH and bilirubin monitoring (Bilitec

2000) were done to all patients. RESULTS: Seventy one patients (78.0%) had ERD

(Savary- (grade I-III), 11 patients (12.1%) had NERD and 9 patients (9.9%)

had BE suspected endoscopically and diagnosed by histological esophageal biopsy.

Combined 24-h esophageal bilirubin and pH monitoring revealed that 39 patients

(42.9%) had mixed acid and bile reflux, 16 (17.6%) had pathological acid reflux

only, 18 (19.8%) had bile reflux only and 18 patients (19.8%) had no evidence of

abnormal reflux. The percentage of the total time of bilirubin absorbance above

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 BE patients

had abnormal esophageal bile reflux (3 bile alone and 6 mixed bile and acid); 44

of 71 patients (61.97%) with ERD had abnormal esophageal bile reflux (13 bile

alone and 31 mixed bile and acid); meanwhile 15 of them (21.2%) had abnormal

acid exposure alone. Of the 11 patients with NERD, 4 patients (36.4%) had

abnormal esophageal bile reflux, 2 of them mixed with acid. CONCLUSIONS: The

Bilitec method reliably identifies the presence of bilirubin and quantitatively

detects duodenogastroesophageal reflux of bile. Mixed reflux (acid and bile) is

the chief pattern of reflux in GERD patients in this study. Bile reflux either

alone or mixed with acid reflux contributes to the severity of erosive and

non-erosive reflux disease as well as to Barrett's esophagus.

PMID: 18613384 [PubMed - indexed for MEDLINE]

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