[Quantifying intestino-esophageal reflux with a fiberoptic bilirubin detection probe].
Currently available methods to assess reflux of duodenal contents into the esophagus are cumbersome, unphysiologic, and inaccurate. The role of intestino-esophageal reflux has therefore been controversial. We assessed intestino-esophageal reflux using a new system which allows prolonged intraesophageal measurement of bilirubin, the major pigment of bile. Measurements were made with a newly developed fiber-optic sensor electrode connected to a portable data processing unit (BILITEC 2000, Synectics Medical Inc., Sweden). Light absorption was measured at the absorption peak of bilirubin and a reference point. Studies were performed in 9 subjects without esophagitis, 9 subjects with esophagitis and primary reflux disease and 7 subjects with erosive esophagitis after a total or subtotal gastrectomy. The fiberoptic electrode was placed 5 cm above the lower esophageal sphincter. In vitro studies showed linear correlations between absorbance measurements obtained with the BILITEC-unit and known bilirubin and bile acid concentrations, respectively (p < 0.01). Compared to both other groups, light absorption was markedly increased in the subjects who had esophagitis after a total or subtotal gastrectomy (p < 0.05) indicating severe biliary reflux. An increase in bilirubin absorption occurred particularly during the post-prandial and supine periodes (p < 0.01). A Roux-en-Y biliary diversion procedure completely abolished bile reflux in 2 of these patients. These data indicate that ambulatory 24-hour fiberoptic measurement of bilirubin in the esophagus is feasible and allows quantitation of intestino-esophageal reflux. Intestino-esophageal reflux occurs particularly during the postprandial period and the early morning hours in patients who had a previous subtotal or total gastrectomy.
Stein
H J
HJ
Chirurgische Klinik und Poliklinik, Technische Universität München.
Kraemer
S J
SJ
Feussner
H
H
Siewert
J R
JR
D000328:Adult; D000368:Aged; D000713:Anastomosis, Roux-en-Y; D001647:Bile Acids and Salts / Q000032:analysis; D001655:Bile Reflux / Q000175:diagnosis*; D001663:Bilirubin / Q000032:analysis*; D002408:Catheters, Indwelling; D004942:Esophagitis, Peptic / Q000175:diagnosis*; D005260:Female; D005336:Fiber Optic Technology / Q000295:instrumentation*; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000295:instrumentation*; D055100:Optical Fibers; D011178:Postgastrectomy Syndromes / Q000175:diagnosis*; D013053:Spectrophotometry / Q000295:instrumentation*
D001647:Bile Acids and Salts; D001663:Bilirubin
Quantifizierung des intestino-ösophagealen Refluxes mit einer fiberoptischen Bilirubin-Messonde.