Fiberoptic technique for 24-hour bile reflux monitoring. Standards and normal values for gastric monitoring.
Physiologic bile reflux was assessed in 27 in vivo test with healthy volunteers to define a standardized protocol and normal values for 24-hour enterogastric bile reflux monitoring (protocol with supine, upright, and meal phases and a free diet avoiding alcohol, smoking, and coffee, evaluation with different thresholds of absorbance units: 0.14, 0.25). In vitro tests with bile-sodium solutions demonstrated a linear dependence of absorbance for bilirubin up to 600 mumol/liter (range of the fiberoptic device: 0.0-1.0). Fluids and food might interfere with absorbances below 0.25 (exception: coffee). In vivo bile often remains in the stomach for more than 1 hr; these events were defined as reflux episodes. The upper limits for physiologic bile reflux are a percentage of total time of bile reflux of 28.2% and an average absorbance during a reflux episode of 0.62 (95th percentile with threshold 0.25). Comparing bile with pH monitoring (absorbance > 0.25 and/or pH > 4), an increase of bilirubin was found most frequently with constant pH (45%) or an increase of pH with constant bilirubin (36%). The hypothesis was drawn that bile and duodenal or pancreatic secretions may separately contribute to duodenogastric reflux.
Fein
M
M
University of Würzburg, Department of Surgery, Germany.
Fuchs
K H
KH
Bohrer
T
T
Freys
S M
SM
Thiede
A
A
D000328:Adult; D001646:Bile / Q000502:physiology*; D001655:Bile Reflux / Q000503:physiopathology*; D001663:Bilirubin / Q000032:analysis; D004326:Drinking; D004435:Eating; D005260:Female; D005336:Fiber Optic Technology; D005745:Gastric Acidity Determination; D006801:Humans; D066298:In Vitro Techniques; D008297:Male; D008875:Middle Aged; D018670:Monitoring, Ambulatory / Q000295:instrumentation*; D012016:Reference Values; D015203:Reproducibility of Results; D013270:Stomach / Q000502:physiology* / Q000503:physiopathology
D001663:Bilirubin