Bile in the oesophagus: clinical relevance and ambulatory detection.
BACKGROUND
Experimental work in animals has implicated a role for bile in the pathogenesis of several oesophageal mucosal diseases such as oesophagitis, Barrett's oesophagus and oesophageal adenocarcinoma. Recent descriptions of a high incidence of intestinal metaplasia at the gastro-oesophageal junction in patients without a classical 3-cm Barrett's columnar-lined segment, combined with a rising incidence in oesophageal and cardia adenocarcinoma, have stimulated interest in the causes of these conditions.


RESULTS
Animal studies concerned with defining the role of the various gastroduodenal reflux constituents in oesophageal mucosal injury are summarized and evidence for bile in the pathogenesis of Barrett's oesophagus and oesophageal adenocarcinoma is reviewed. The results of various techniques for clinical measurement of oesophageal bile reflux, such as aspiration, scintigraphy and pH monitoring, are evaluated and the significance of recent studies employing ambulatory fibreoptic bilirubin monitoring is discussed.


CONCLUSIONS
There seems little doubt that bile plays a significant role in oesophageal mucosal disease, in synergy with other constituents of reflux. Although ambulatory bilirubin monitoring is new, some intriguing findings have been reported and it is hoped that this technique will continue to shed light on the role of bile in the oesophagus.
Marshall
R E
RE
Department of Surgery, Guy's Hospital, London, UK.
Anggiansah
A
A
Owen
W J
WJ
D001471:Barrett Esophagus / Q000209:etiology; D001646:Bile; D001663:Bilirubin / Q000032:analysis; D004935:Esophageal Diseases / Q000209:etiology*; D004938:Esophageal Neoplasms / Q000209:etiology; D005764:Gastroesophageal Reflux / Q000209:etiology; D006801:Humans; D006863:Hydrogen-Ion Concentration; D013274:Stomach Neoplasms / Q000209:etiology
D001663:Bilirubin