The Ambulatory Fiberoptic Reflux Monitoring in Bile Reflux Gastritis - Histologic Changes and Duodenogastric Reflux

Background: Bile reflux gastritis is known to be one of non-ulcer dyspepsia. Bile reflux occurs sporadi- cally and duodenogastric reflux disease cannot be accurately diagnosed by endoscopy. The main pro- blem in diagnosis of bile reflux gastritis is the lack, of a gold standard for enterogastric reflux measure- ment. We performed ambulatory fiberoptic reflux monitoring(Bilitec 2000, Synetics) on bile reflux gastritis patients. The aims of this study were 1) to evaluate the role of ambulatory fiberoptic reflux monitoring in the diagnosis of bile reflux gastritis. 2) to evaluate the extent and pattern of duodenogastric reflux in bile reflux gastritis patients. 3) to know the interrelationship between the extent of bile reflux and severity of histologic changes in intact stomach. Materials and Methods: Eighteen endoscopically diagnosed bile reflux gastritis patients and 10 controls who had no endoscopic evidence of bile reflux underwent ambulatory fiberoptic reflux monitoring(Bilitec 2000, Synetics). Tissue specimens for histologic study were obtained endoscopically from antrum 2 ctn proximal to the pylorus from each patient. Results: In bile reflux gastritis, the bile reflux duration(percentages of total measured time above absorbance 0.14) was found to be significantly higher than the control group(33.6+13.3% vs 5.7+ 2.7%, pC0.05). Bile reflux duration was longer in supine periods than in upright periods(43.8+4.30% vs 23.3+4.0%, p0.05). The nighttime bile reflux was higher than daytime significantly(47.7+4.5% vs 17.1+4.5Fo) in bile reflux gastritis. There was no correlation between bile reflux duration and histolo- gic changes in bile reflux gastritis(r=-0.47, p=0.09). Conclusions: Ambulatory fiberoptic reflux monitoring is useful in diagnosis of enterogastric reflux. Bi]e reflux occurs main)y in supine period of nighttime and the duration of bile reflux has no relationship with severity of histologic changes.