MATERIALS AND METHODS: Ninety-one patients complaining of reflux symptoms were studied with upper gastrointestinal endoscopy and graded to nonerosive reflux disease (NERD), erosive reflux disease (ERD) and BE. Esophageal manometry and simultaneous ambulatory 24-h esophageal pH and
bilirubin monitoring (Bilitec 2000) were performed in 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, which were suspected endoscopically and diagnosed by histological esophageal biopsy. Combined 24-h esophageal
bilirubin and pH monitoring revealed the following: 39 patients (42.9%) had mixed
acid and
bile reflux, 16 (17.6%) had pathological
acid reflux alone, 18 (19.8%) had
bile reflux alone and 18 patients (19.8%) showed no evidences of abnormal reflux. The percentage of the total time of the
bilirubin absorbance > 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 the BE patients had abnormal esophageal
bile reflux (bile alone (3 patients)); and mixed bile and
acid (6 patients)); 44 of 71 patients (61.97%) with ERD had abnormal esophageal
bile reflux (alone (13 patients) and mixed bile and
acid (31 patients)); meanwhile, 15 of them (21.2%) had abnormal
acid exposure alone. Despite 11 patients having NERD, four patients (36.4%) had abnormal esophageal
bile reflux and two of them had mixed reflux of bile with
acid.
CONCLUSION: We believe that the Bilitec method reliably identifies the presence of
bilirubin and quantitatively detects the duodenogastroesophageal reflux of bile. Mixed reflux (
acid and bile) is the chief pattern of reflux in our
GERD patients.
Bile reflux either alone or along with
acid reflux contributes to the severity of erosive and nonerosive reflux diseases as well as in BE.