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Journal of Gastrointestinal Surgery

, Volume 1, Issue 1, pp 27–33 | Cite as

Duodenogastric reflux potentiates the injurious effects of gastroesophageal reflux

  • Martin Fein
  • Adrian P. Ireland
  • Manfred P. Ritter
  • Jeffrey H. Peters
  • Jeffrey A. Hagen
  • Cedric G. Bremmer
  • Tom R. DeMeester
Original article

Abstract

Experimental studies have shown that the severity of esophageal mucosal injury in gastroesophageal reflux disease is related to the reflux of both gastric and duodenal juice. The purpose of this study was to determine whether duodenal juice potentiates esophageal injury in patients with reflux disease or, inf act, causes no harm allowing acid and pepsin to do the damage. A total of 148 consecutive patients who had no previous gastric or esophageal surgery underwent endoscopy and biopsy, manometry, and 24-hour esophageal pH and bilirubin monitoring. Esophageal injury was defined by the presence of erosive esophagitis, stricture, or biopsy-proved Barrett's esophagus. Exposure to duodenal juice, identified by the absorbance of bilirubin, was defined as an exposure time exceeding the ninety-fifth percentile measured in 35 volunteers. To separate the effects of gastric and duodenal juice, patients were stratified according to their acid exposure time. One hundred patients had documented acid reflux on pH monitoring, and in 63 of them it was combined with reflux of duodenal juice. Patients with combined reflux (50 of 63) were more likely to have injury than patients without combined reflux (22 of 37; P < 0.05). When the acid exposure time was greater than 10%, patients with injury (n = 40) had a greater exposure to duodenal juice (median exposure time 17.2% vs. 1.1%, P = 0.006) than patients without injury (n = 5), but there was no difference in their acid exposure (16.9% vs. 13.4%). Patients with dysplasia of Barrett's epithelium (n = 9) had a greater exposure to duodenal juice (median exposure time 30.2% vs. 7.2%, P = 0.04) compared to patients without complications (n = 25), whereas acid exposure was the same (16.4% vs. 15%). Duodenal juice adds a noxious component to the refluxed gastric juice and potentiates the injurious effects of gastric juice on the esophageal mucosa.

Keywords

Acid Exposure Erosive Esophagitis Esophageal Acid Exposure Esophageal Injury Duodenal Juice 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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Copyright information

© The Society Surgery of the Alimentary Tract 1997

Authors and Affiliations

  • Martin Fein
    • 1
  • Adrian P. Ireland
    • 1
  • Manfred P. Ritter
    • 1
  • Jeffrey H. Peters
    • 1
  • Jeffrey A. Hagen
    • 1
  • Cedric G. Bremmer
    • 1
  • Tom R. DeMeester
    • 1
  1. 1.Department of Surgery, University of Southern California School of MedicineLos Angeles, Calif.USA

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