title: Acid and bile reflux in erosive reflux disease, non-erosive reflux disease and Barrett's esophagus.
abstract: OBJECTIVE
  Gastroesophageal reflux disease (GERD) may occur with acid, bile or in a mixed form. Endoscopic injury and mucosal metaplasia are a known sequlae to pathological GERD. The aim of the study was to determine the contribution of acid and duodenogastroesophageal reflux (DGER) to endoscopic severity in patients with GERD and Barrett's esophagus.
  
  
  METHODS
  Ninety-one patients complaining of reflux symptoms were studied with upper gastrointestinal endoscopy and graded to non-erosive reflux disease (NERD), erosive reflux disease (ERD) and Barrett's esophagus (BE). Esophageal manometry and simultaneous ambulatory 24-h esophageal pH and bilirubin monitoring (Bilitec 2000) were done to all patients.
  
  
  RESULTS
  Seventy one patients (78.0%) had ERD (Savary-Miller (grade I-III), 11 patients (12.1%) had NERD and 9 patients (9.9%) had BE suspected endoscopically and diagnosed by histological esophageal biopsy. Combined 24-h esophageal bilirubin and pH monitoring revealed that 39 patients (42.9%) had mixed acid and bile reflux, 16 (17.6%) had pathological acid reflux only, 18 (19.8%) had bile reflux only and 18 patients (19.8%) had no evidence of abnormal reflux. The percentage of the total time of bilirubin absorbance above 0.14, in 71 patients with ERD was (8.18 +/- 11.28%), and in 9 patients with BE was (15.48 +/- 30.48%) which was significantly greater than that in 11 patients with NERD (4.48 +/- 8.99%), p < 0.05 and p = 0.01 respectively. All BE patients had abnormal esophageal bile reflux (3 bile alone and 6 mixed bile and acid); 44 of 71 patients (61.97%) with ERD had abnormal esophageal bile reflux (13 bile alone and 31 mixed bile and acid); meanwhile 15 of them (21.2%) had abnormal acid exposure alone. Of the 11 patients with NERD, 4 patients (36.4%) had abnormal esophageal bile reflux, 2 of them mixed with acid.
  
  
  CONCLUSIONS
  The Bilitec method reliably identifies the presence of bilirubin and quantitatively detects duodenogastroesophageal reflux of bile. Mixed reflux (acid and bile) is the chief pattern of reflux in GERD patients in this study. Bile reflux either alone or mixed with acid reflux contributes to the severity of erosive and non-erosive reflux disease as well as to Barrett's esophagus.
authors.affiliation: Gastroenterology Surgical Center, Mansoura University, Mansoura, Egypt. gadelhak_n_eg@hotmail.com
authors.forename: Nabil GadEl
authors.initials: NG
authors.lastname: Hak
authors.forename: Mohamed
authors.initials: M
authors.lastname: Mostafa
authors.forename: Tarek
authors.initials: T
authors.lastname: Salah
authors.forename: Mohamed
authors.initials: M
authors.lastname: El-Hemaly
authors.forename: Magdy
authors.initials: M
authors.lastname: Haleem
authors.forename: Ahmed
authors.initials: A
authors.lastname: Abd El-Raouf
authors.forename: Emad
authors.initials: E
authors.lastname: Hamdy
mesh_terms: D000328:Adult; D001471:Barrett Esophagus / Q000150:complications* / Q000175:diagnosis; D004383:Duodenogastric Reflux / Q000150:complications* / Q000175:diagnosis; D004384:Duodenoscopy; D004945:Esophagoscopy; D005260:Female; D005764:Gastroesophageal Reflux / Q000150:complications* / Q000175:diagnosis; D005773:Gastroscopy; D006801:Humans; D008297:Male; D012720:Severity of Illness Index