title: Presence of bile in the oesophagus is associated with less effective oesophageal motility.
abstract: OBJECTIVE
  Reflux of bile to the oesophagus has been shown to be of importance in the development of gastro-oesophageal reflux disease. This study aims to assess oesophageal motility patterns in relation to acid and bile reflux to the oesophagus.
  
  
  METHODS
  Forty-nine subjects with and without reflux disease underwent 24-hour ambulatory recordings of oesophageal pH, bile and 3-channel manometry. Gastroscopy was performed to assess severity of oesophagitis. The percentage of effective peristaltic contractions (oesophageal contractions with a peristaltic pattern and a pressure >30 mm Hg) were correlated to the degree of acid and bile reflux. Ten subjects were re-evaluated within 2 years post-fundoplication.
  
  
  RESULTS
  Acid and bile reflux were associated with fewer effective contractions (R(2) = 0.07, p = 0.06 and R(2) = 0.21, p = 0.008, respectively). However, in a multivariate model including acid, bile, age and gender dependency, only bile could show a systematic effect on the variation in percentage of effective peristaltic contractions (R(2) = 0.22, p = 0.001). One year after laparoscopic fundoplication, 24-hour oesophageal motility was unchanged.
  
  
  CONCLUSIONS
  Reflux of duodenal juice to the oesophagus is associated with less effective oesophageal motility, which in turn can perpetuate the disease by less effective oesophageal clearance of bile and acid. The reduced oesophageal motility is not reversed by fundoplication.
authors.affiliation: Division of Surgery, Karolinska Institutet Danderyd Hospital, Danderyd, Sweden. Jacob.Freedman@kir.ds.sll.se
authors.forename: Jacob
authors.initials: J
authors.lastname: Freedman
authors.forename: Madeleine
authors.initials: M
authors.lastname: Lindqvist
authors.forename: Per M
authors.initials: PM
authors.lastname: Hellström
authors.forename: Lars
authors.initials: L
authors.lastname: Granström
authors.forename: Erik
authors.initials: E
authors.lastname: Näslund
mesh_terms: D001655:Bile Reflux / Q000503:physiopathology*; D004947:Esophagus / Q000503:physiopathology*; D005260:Female; D018662:Fundoplication; D005764:Gastroesophageal Reflux / Q000503:physiopathology* / Q000601:surgery; D006801:Humans; D006863:Hydrogen-Ion Concentration; D008297:Male; D008365:Manometry; D008875:Middle Aged; D018670:Monitoring, Ambulatory; D010528:Peristalsis