title: Ambulatory intraesophageal bilirubin monitoring in Japanese patients with gastroesophageal reflux.
abstract: BACKGROUND
  The role of reflux of duodenal contents in gastroesophageal reflux in Japanese patients, which may be different from that in Western patients, was studied.
  
  
  METHODS
  Intraesophageal pH and the bilirubin concentration were monitored, using the Bilitec 2000, in 43 patients with reflux symptoms and 10 normal volunteers. The percentage of the time that spectrophotometric absorbance was 0.15 or more and pH was less than 4.0 was defined as the holding times (HTs) of bilirubin and acid, respectively. Severity of esophagitis was classified using the Savary-Miller (S-M) classification.
  
  
  RESULTS
  Esophagitis was present in 37 patients; 5, 10, 13, and 9 patients had S-M grades 1, 2, 3, and 4, respectively. Both HTs in the volunteers were less than 5%. Bilirubin HT was more than 5% in 3 of the 6 patients without esophagitis, but the acid HT was less than 5% in these 6 patients. Acid HT was less than 5% in 4, 2, 2, and 2 patients with S-M grades 1, 2, 3, and 4, respectively. Bilirubin HT was less than 5% in 1 patient with S-M grade 2 esophagitis. Bilirubin HT in patients with S-M grades 3 and 4 esophagitis (50.9 +/- 5.8%) was higher than that in grades 1 and 2 (14.9 +/- 2.9%) (P < 0.0001), but this was not so for acid HT. In 32 patients, bilirubin HT exceeded acid HT. Bilirubin HT did not correlate with acid HT.
  
  
  CONCLUSIONS
  Duodenogastroesophageal reflux occurred independently of and exceeded acid reflux. The amount of duodenogastroesophageal reflux correlated with the severity of esophagitis.
authors.affiliation: Department of Gastroenterological Surgery, Osaka City University Medical School, 1-4-3 Asahi-machi, Abeno-ku, Osaka 545-8586, Japan.
authors.forename: Harushi
authors.initials: H
authors.lastname: Osugi
authors.forename: Masayuki
authors.initials: M
authors.lastname: Higashino
authors.forename: Susumu
authors.initials: S
authors.lastname: Kaseno
authors.forename: Nobuyasu
authors.initials: N
authors.lastname: Takada
authors.forename: Masashi
authors.initials: M
authors.lastname: Takemura
authors.forename: Masakatsu
authors.initials: M
authors.lastname: Ueno
authors.forename: Yoshinori
authors.initials: Y
authors.lastname: Tanaka
authors.forename: Kenichirou
authors.initials: K
authors.lastname: Fukuhara
authors.forename: Yushi
authors.initials: Y
authors.lastname: Fujiwara
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Kinoshita
mesh_terms: D000328:Adult; D000368:Aged; D001663:Bilirubin / Q000032:analysis*; D004383:Duodenogastric Reflux / Q000150:complications* / Q000503:physiopathology*; D004942:Esophagitis, Peptic / Q000209:etiology* / Q000503:physiopathology*; D004947:Esophagus / Q000737:chemistry* / Q000503:physiopathology*; D005260:Female; D005764:Gastroesophageal Reflux / Q000150:complications* / Q000503:physiopathology*; D006801:Humans; D007564:Japan; D008297:Male; D008875:Middle Aged; D018670:Monitoring, Ambulatory; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index
chemical_list: D001663:Bilirubin