title: Bile and acid reflux in the pathogenesis of reflux oesophagitis in children.
abstract: OBJECTIVE
  The aim of this study was to investigate the role of bile and acid reflux in the pathogenesis of reflux oesophagitis (RE) in children.
  
  
  METHODS
  A total of 44 patients aged 5-17 years with gastro-oesophageal reflux symptoms were enrolled. Simultaneous 24-h oesophageal Bilitec 2000 (Medtronic Instruments, Minneapolis, MN, USA) bilirubin monitoring and pH monitoring, in biopsy of oesophageal mucosa by gastro-endoscopy, were performed in all patients.
  
  
  RESULTS
  According to the diagnostic criteria of pathological acid reflux and pathological bile reflux, 10 of 44 cases (22.7%) had acid reflux, 10 (22.7%) had isolated bile reflux, 16 (36.4%) had mixed acid and bile reflux, and the other eight (18.2%) had no reflux. Significant difference was observed in the ratio of different patterns of reflux between the RE group (26 cases) and the non-erosive reflux disease (NERD) group (18 cases) (chi(2) = 9.096, P < 0.01). All the parameters of acid reflux in the RE group were higher significantly than that in the NERD group (P < 0.05 or P < 0.01). A total of 20 out of 26 cases (76.9%) with RE had oesophageal acid reflux as against six out of 18 cases (33.3%) in patients with NERD (P < 0.01). The difference of each parameter of bile reflux had not reached significance between the two groups.
  
  
  CONCLUSIONS
  Mixed reflux is the predominant form of reflux in the causation of oesophageal mucosal injury in children. Isolated bile reflux also plays a role in the development of RE, although only in patients without acid reflux.
authors.affiliation: Department of Gastroenterology, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China. mizu@zju.edu.cn
authors.forename: Mizu
authors.initials: M
authors.lastname: Jiang
authors.forename: Jie
authors.initials: J
authors.lastname: Chen
authors.forename: Feibo
authors.initials: F
authors.lastname: Chen
authors.forename: Jindan
authors.initials: J
authors.lastname: Yu
authors.forename: Jianfeng
authors.initials: J
authors.lastname: Liang
authors.forename: Yanyi
authors.initials: Y
authors.lastname: Zhang
authors.forename: Biyou
authors.initials: B
authors.lastname: Ou
mesh_terms: D000293:Adolescent; D001655:Bile Reflux / Q000150:complications* / Q000175:diagnosis / Q000378:metabolism / Q000473:pathology; D001663:Bilirubin / Q000378:metabolism; D002648:Child; D002675:Child, Preschool; D050782:Esophageal pH Monitoring; D004942:Esophagitis, Peptic / Q000175:diagnosis / Q000209:etiology* / Q000378:metabolism / Q000473:pathology; D004945:Esophagoscopy; D005260:Female; D005764:Gastroesophageal Reflux / Q000150:complications* / Q000175:diagnosis / Q000378:metabolism / Q000473:pathology; D006801:Humans; D008297:Male; D018670:Monitoring, Ambulatory; D012680:Sensitivity and Specificity
chemical_list: D001663:Bilirubin