The relationship between acid and bile reflux and symptoms in gastroesophageal reflux

Objective To investigate the contribution of acid and bile reflux to symptoms in patients with presumed GERD.Methods A total of 56 patients with typical reflux symptoms underwent 24 hour ambulatory pH and Bilitec monitoring.Patients pressed a marker button when experiencing typical symptoms.For each symptom episode,minimal pH and maximal bilirubin optical density in a 2 min interval were calculated.For each patient,the symptom indexes(SI) including acid reflux(SIa) and bile reflux (SIb) were calculated.Results A total of 357 symptom episodes were identified.Most symptom events(37.25%) were associated with acid reflux and only 7.56% of symptom events were with bile reflux alone.In the patients with esophageal reflux,243 symptom events were registered,of which 105(43.21%) were associated with acid reflux while 21(8.64%) with bile reflux.There was a significant difference in the SI mean value between SIa and SIb.Conclusion Symptom episodes in patients with presumed GERD are more related to acid reflux than bile reflux.Bile reflux does not seem to play a major role in producing typical esophageal symptoms.