Obesity Surgery

, Volume 28, Issue 2, pp 559–566 | Cite as

Detecting Bile Reflux—the Enigma of Bariatric Surgery

  • Thomas A. Eldredge
  • Jennifer C. Myers
  • George K. Kiroff
  • Jonathan ShenfineEmail author
Review Article


Duodeno-gastro-esophageal reflux, or bile reflux, is a condition for which there is no diagnostic gold standard, and it remains controversial in terms of carcinoma risk. This is pertinent in the context of an increasingly overweight population who are undergoing weight-loss operations that theoretically further increase the risk of bile reflux. This article reviews investigations for bile reflux based on efficacy, patient tolerability, cost, and infrastructure requirements. At this time, whilst no gold standard exists, hepatobiliary scintigraphy is the least invasive investigation with good-patient tolerability, sensitivity, and reproducibility to be considered first-line for diagnosis of bile reflux. This review will guide clinicians investigating bile reflux.


Bile reflux Fiberoptic spectrophotometry Impedance Scintigraphy Endoscopy 



Australian dollars


Duodenogastroesophageal reflux




Hepatobiliary iminodiacetic acid


Lower esophageal sphincter


Multi-channel intraluminal impedance-pH


Single-photon emission computed tomography



Thank you to Associate Professor Dylan Bartholomeusz (Royal Adelaide Hospital Nuclear Medicine Department) and Ms. Josie Burfield and Mr. Marcus Tippett (Royal Adelaide Hospital Department of Gastrointestinal Investigation) for their input regarding the costing of investigations.

Author Contributions

T.A.E. and J.S. conceived and designed research; T.A.E. undertook the literature search and analyzed the data; T.A.E. interpreted the results; T.A.E. and J.C.M. drafted manuscript; T.A.E., J.C.M., G.K.K., and J.S. edited and revised manuscript; T.A.E., J.C.M., G.K.K., and J.S. approved final version of manuscript.


No industry or other external funding was used for this research.

Compliance with Ethical Standards

Conflict of Interest

Author 1, Author 3, and Author 4 have no conflicts of interest or financial to declare. Author 2 provides educational activities for Medtronic Australasia.

Ethical Approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed Consent

Does not apply to this study.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2017

Authors and Affiliations

  • Thomas A. Eldredge
    • 1
    • 2
  • Jennifer C. Myers
    • 1
    • 2
    • 3
  • George K. Kiroff
    • 1
    • 2
  • Jonathan Shenfine
    • 1
    • 3
    Email author
  1. 1.Discipline of Surgery, School of MedicineUniversity of AdelaideAdelaideAustralia
  2. 2.Department of SurgeryQueen Elizabeth HospitalWoodville SouthAustralia
  3. 3.Department of SurgeryRoyal Adelaide HospitalAdelaideAustralia

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