Esophageal pH and bile monitoring for detecting duodenogastroesophageal reflux and evaluating the effectiveness of treatment.

Objective To study the diagnostic methodlogy of duodenogastroesophageal reflux (DGER) and to evaluate the role of bile reflux in gastroesophageal reflux disease (GERD). Methods Simultaneous 24 hour esophageal bilirubin levels and pH monitoring were performed in 20 healthy subjects(HS) and 52 patients with symptoms suggesting gastroesophageal reflux with Bilitec 2000 apparatus and Digitrapper MKⅢ ambulatory pH recorder. An absorbance value ≥0.14 was designated as the threshold value for the presence of bile reflux. Patients suffering from mixed pathologic reflux of acid and bile were treated with hydrotalcite and cisapride for four weeks, then the monitorings were repeated. Results No pathologic acid reflux were found in 20 HS. Fourty seven of 52 patients were found to have pathologic reflux by 24 hour esophageal pH metry. The total fraction time of bile reflux was higher in 52 patients than those in 20 HS (2.67%±3.23% vs. 0.47% ± 0.71% , P 0.05), and was higher in 12 patients with esophagitis than in 35 patients without esophagitis (5.41%± 4.93% vs. 1.68% ±1.76%, P 0.05). Among 47 patients with GERD, 15(32%) showed abnormal acid and bile mixed reflux. Eight cases of esophagitis were found in 15 patients with mixed reflux and only 4 cases of esophagitis in the 32 patients with acid reflux alone ( P 0.05). After treatment with hydrotalcite and cisapride, the total fraction time of acid and bile reflux in 15 patients with mixed reflux decreased significantly ( P 0.05), and the esophagitis were healed in 7 of 8 patients. Conclusions Bilitec 2000 may be a useful tool for detecting DGER and evaluating its treatment. About 32%(15/47) of patients with GERD were found to be DGER. Bile reflux may play a significant role in esophageal mucosal damage of GERD.