The role of 24-hr gastric pH-monitoring in the interpretation of 24-hr gastric bile monitoring for duodenogastric reflux.
OBJECTIVE
Duodenogastric reflux is a physiologic phenomenon. For a number of years, alkalinization of the acidic intragastric pH environment, as assessed by 24-hour gastric pH-monitoring, was thought to be caused by duodenogastric reflux. The recent introduction of the fotooptic Bilitec system for intraluminal bilirubin measurement has created the possibility to directly quantify a component of duodenal juice.


METHODS
In this study, 24-hour gastric pH-monitoring and 24-hour bilirubin monitoring were performed in healthy subjects. The upper limits for physiologic bile reflux are the 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).


RESULTS
Comparing bile with pH-monitoring (absorbance > 0.25 and/or pH > 4), an increase of bilirubin was found most frequently with constant pH (43%) or an increase of pH with constant bilirubin (37%).


CONCLUSIONS
The hypothesis was drawn that the composition of duodenogastric refluxate can vary. Bile and pancreatic juice may separately contribute to duodenogastric reflux.
Fuchs
K H
KH
Chirurgische Universitatsklinik und Poliklinik, Wurzburg.
Fein
M
M
Maroske
J
J
Heimbucher
J
J
Freys
S M
SM
D001646:Bile / Q000378:metabolism; D001655:Bile Reflux / Q000503:physiopathology*; D001663:Bilirubin / Q000378:metabolism; D004383:Duodenogastric Reflux / Q000503:physiopathology; D005744:Gastric Acid / Q000378:metabolism; D006801:Humans; D006863:Hydrogen-Ion Concentration; D008991:Monitoring, Physiologic; D019518:Postprandial Period; D012984:Software
D001663:Bilirubin