The role of detecting bile reflux in the diagnosis of gastroesophageal reflux disease

Objective To investigate the incidence of esophageal bile reflux and its relationship with acid or alkaline reflux and to evaluate the significance of detecting bile reflux in the diagnosis of gastroesophageal reflux disease (GERD). Methods Using ambulatory 24 hour pH monitoring and bilirubin monitoring technique, the changes of 24 hour intraesophageal pH and bile reflux in 34 subjects (including healthy subjects, patients with reflux esophagitis and patients after gastrectomy) were simultaneously assessed. Results The time of esophageal acid exposure for reflux esophagitis (RE) patients was significantly longer than that in the controls and the patients after gastrectomy, but there was no difference between postgastrectomized patients and healthy controls. Total percent time of pH8 in each group was similar and were very low. Bile reflux [duodenogastroesophageal reflux (DGER)], represented by total time percentage of bilirubin absorbance ≥0.14, was greatest in postgastrectomized patients, and next in the patients with RE, but the value in both groups was significantly higher than that in the controls. There was a close association between DGER and total time percentage of pH4 ( r =0.75, P 0.05) but a poor relationship ( r =0.17) with total time percentage pH8. 63.6% of the patients with RE had acid and bile reflux simultaneously. Conclusion DGER is common in GERD and postgastrectomized patients. It can occur with acid reflux and may play a role in the development of GERD. It is very important to monitor acid and bile reflux at the same time in the diagnosis of GERD.