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: