title: The extent of duodenogastric reflux in gastro-oesophageal reflux disease.
abstract: BACKGROUND
  It is known that duodenogastro-oesophageal reflux (DGOR) increases with worsening gastro-oesophageal reflux disease (GORD). It is unclear whether this is accompanied by increasing duodenogastric reflux (DGR).
  
  
  OBJECTIVE
  To investigate the extent of DGR in a control group and 66 patients with GORD, using the technique of ambulatory gastric bilirubin monitoring.
  
  
  METHODS
  Sixty-six patients with reflux symptoms (30 grade 0 or 1 oesophagitis (group 1), 16 grade 2 or 3 oesophagitis (group 2), 20 Barrett's oesophagus (group 3)) and 17 healthy controls were studied. All underwent oesophageal manometry followed by 24-h ambulatory oesophageal and gastric pH monitoring and gastric bilirubin monitoring.
  
  
  RESULTS
  Median per cent total oesophageal acid exposure (pH < 4) was significantly less in the control group (0.6%) than in group 1 (2.8%, P< 0.05) and groups 2 and 3 (7.5% and 7.8% respectively, P< 0.001). There was no significant difference between any group in median per cent total time gastric pH was greater than 4. There was no significant difference in median per cent total gastric bilirubin exposure (absorbance > 0.14) between any group. However, in each group gastric bilirubin exposure was greater in the supine position than the upright position, being significantly greater in the control group (P< 0.05) and group 1 (P < 0.001).
  
  
  CONCLUSIONS
  Gastric bilirubin exposure is similar across the spectrum of GORD severity. It is greater in the supine than in the upright position.
authors.affiliation: Department of Surgery, Guy's Hospital, London, UK. bobandtup@hotmail.com
authors.forename: R E
authors.initials: RE
authors.lastname: Marshall
authors.forename: A
authors.initials: A
authors.lastname: Anggiansah
authors.forename: W A
authors.initials: WA
authors.lastname: Owen
authors.forename: D K
authors.initials: DK
authors.lastname: Manifold
authors.forename: W J
authors.initials: WJ
authors.lastname: Owen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001663:Bilirubin / Q000032:analysis; D004383:Duodenogastric Reflux / Q000150:complications* / Q000503:physiopathology; D004386:Duodenum / Q000503:physiopathology; D005260:Female; D005753:Gastric Mucosa / Q000737:chemistry; D005764:Gastroesophageal Reflux / Q000150:complications* / Q000503:physiopathology; D006801:Humans; D008297:Male; D008365:Manometry; D008875:Middle Aged; D013270:Stomach / Q000503:physiopathology
chemical_list: D001663:Bilirubin