Simultaneous bilimetry and pHmetry in GERD and Barrett's patients.
OBJECTIVE
Despite the progressive development of technology and better knowledge of physiopathology, GERD diagnosis remains a medical problem. The aim of the study is to verify whether the measurement of bile reflux can increase the diagnostic accuracy of GERD.


METHODS
6 healthy volunteers adhered to a standard protocol, 11 Barrett's patients and 15 GERD patients (endoscopic erosive esophagitis) were fasted for 6 h before any examinations and the patients ceased acid suppression medications 72 h earlier. Manometric study was performed to localize the LES. Then The Bilitec 2000 fiberoptic probe (Synectics, Medtronics) and an antimony pH probe attached to a Digitrapper Mark III pH recorder (Synectics, Medtronics), together, were inserted through the nostril and positioned 5cm above the LES. They received an uncolored diet and after around 24 h, both Bilitec and pH data were downloaded simultaneously to a personal computer for analysis, using the Synectics software. Absorbance threshold was set at 0.14 absorbance units and acceptable esophageal pH at 4, to verify fraction of time of bile reflux (absorbance > 0.14) and DeMeester score.


RESULTS
Except controls, in whom DeMeester and Johnson scoring and fraction time of absorbance were always normal, all patterns of combined results were observed in GERD and Barrett's patients, showing possibilities of "normal" pHmetry in patients with detectable bile reflux, normal fraction time of absorbance with pathologic pH recording and both normal in GERD (40%) and Barrett's patients (only 18%).


CONCLUSIONS
This study showed that Bilitec measurements combined with 24-hour monitoring of intraluminal pH can offer other diagnostic and screening contributions in GERD and Barrett's patients, but cases of normal pHmetry and spectrophotometry demonstrate that none is definitive in characterization of reflux.
Felix
Valter Nilton
VN
Digestive Motility and Neurogastroenterology, MODINE, São Paulo, Brazil. v.felix@terra.com.br
Viebig
Ricardo Guilherme
RG
D001471:Barrett Esophagus / Q000175:diagnosis*; D001655:Bile Reflux; D005764:Gastroesophageal Reflux / Q000175:diagnosis*; D006801:Humans; D006863:Hydrogen-Ion Concentration; D013053:Spectrophotometry