title: Bile acids and total bilirubin detection in saliva of patients submitted to gastric surgery and in particular to subtotal Billroth II resection.
abstract: OBJECTIVE
  The aim of our study was to detect bile acids and total bilirubin in saliva of gastrectomized patients, to confirm objectively presence of biliary laryngopharyngeal reflux and its relationship with laryngeal mucosa damage.
  
  
  BACKGROUND
  Recently, it has been hypothesized that biliary-reflux may reach the upper aerodigestive tract and enhance development of laryngeal malignancies; nevertheless, the presence of duodenogastric contents in this region has never been revealed.
  
  
  METHODS
  We carried out a prospective observational case-control study on 52 patients (cases) previously submitted to gastric surgery, mainly to subtotal Billroth II resection, and on 51 healthy volunteers (controls). Patients were submitted to clinical interview, esophagogastroduodenal endoscopy, endoscopic laryngeal evaluation, and saliva collection. In all saliva samples, bile acids, total bilirubin, and pepsinogen II were assayed.
  
  
  RESULTS
  In cases, group bile acids levels were recorded in 17 of 52 (32.6%) patients, while in 35 of 52 (67.4%) they were undetectable. All controls were negative to bile acids. In positive cases to bile acids, we found a significant (P < 0.05) correlation between bile acids, total bilirubin, and pepsinogen II values and a significant (P < 0.05) higher prevalence of symptoms and findings of laryngeal damage and of previous laryngeal neoplastic lesions.
  
  
  CONCLUSIONS
  We found detectable levels of bile acids and total bilirubin in saliva of patients submitted to previous gastric surgery, prospecting an intriguing diagnostic role of this dosage in the study of biliary laryngopharyngeal reflux. We finally revealed a high incidence of laryngeal disorders in patients with positive bile acids in saliva.
authors.affiliation: Institute of Otorhinolaryngology, Catholic University of Medicine and Surgery, Catholic University of the Sacred Heart, Policlinico A. Gemelli No. 1, 00168 Rome, Italy. eugenio.decorso@tin.it
authors.forename: Eugenio
authors.initials: E
authors.lastname: De Corso
authors.forename: Silvia
authors.initials: S
authors.lastname: Baroni
authors.forename: Stefania
authors.initials: S
authors.lastname: Agostino
authors.forename: Giovanni
authors.initials: G
authors.lastname: Cammarota
authors.forename: Giovanni
authors.initials: G
authors.lastname: Mascagna
authors.forename: Alice
authors.initials: A
authors.lastname: Mannocci
authors.forename: Mario
authors.initials: M
authors.lastname: Rigante
authors.forename: Jacopo
authors.initials: J
authors.lastname: Galli
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001647:Bile Acids and Salts / Q000032:analysis*; D001655:Bile Reflux / Q000150:complications; D001663:Bilirubin / Q000032:analysis*; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D005763:Gastroenterostomy; D006801:Humans; D006863:Hydrogen-Ion Concentration; D007818:Laryngeal Diseases / Q000175:diagnosis* / Q000209:etiology; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D012463:Saliva / Q000737:chemistry*; D018709:Statistics, Nonparametric; D013272:Stomach Diseases / Q000601:surgery*; D016896:Treatment Outcome
chemical_list: D001647:Bile Acids and Salts; D001663:Bilirubin