Skip to main content
Log in

Gastric Bilirubin Monitoring to Assess Duodenogastric Reflux

  • Published:
Digestive Diseases and Sciences Aims and scope Submit manuscript

Abstract

Duodenogastric reflux (DGR) was assessed with 24-hour gastric bilirubin monitoring in 345 patients (219 men; 49 ± 13 years) with foregut symptoms and 41 healthy subjects (24 men, 28 ± 5 years). Bilirubin exposure was measured as percent time above absorbance level 0.25 and excessive DGR was defined above the 95th percentile of normal values (>24.8%). DGR was highest following Billroth II gastric resection (60 ± 24%, N = 15). Patients after cholecystectomy (28 ± 25%, N = 25), patients with gastroesophageal reflux disease (24 ± 24%, N = 199), and patients with nonulcer dyspepsia (23 ± 21%, N = 61) had a significantly higher exposure to DGR than healthy subjects (7 ± 8%, P < 0.0001). In conclusion, gastric bilirubin monitoring is useful for the assessment of DGR specifically in symptomatic patients following gastric resection. Increased amounts of DGR may further be of clinical importance in patients with reflux disease or nonulcer dyspepsia and following cholecystectomy.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

REFERENCES

  1. Keane FB, Dimagno EP, Malagelada JR: Duodenogastric reflux in humans: its relationship to fasting antroduodenal motility and gastric, pancreatic, and biliary secretion. Gastroenterology 81:726–731, 1981

    Google Scholar 

  2. Schindlbeck NE, Heinrich C, Stellaard F, Paumgartner G, Müller-Lissner SA: Healthy controls have as much bile reflux as gastric ulcer patients. Gut 28:1577–1583, 1987

    Google Scholar 

  3. Ritchie WP: Alkaline reflux gastritis. Ann Surg 203:537–542, 1986

    Google Scholar 

  4. Schoenemann J, Zeidler J: Sequelae of cholecystectomy. Z Gastroenterol 35:139–145, 1997

    Google Scholar 

  5. Bost R, Hostein J, Valenti M, Bonaz B, Payen N, Faure H, Fournet J: Is there an abnormal fasting duodenogastric reflux in nonulcer dyspepsia? Dig Dis Sci 35:193–199, 1990

    Google Scholar 

  6. Miwa K, Hattori T, Miyazaki I: Duodenogastric reflux and foregut carcinogenesis. Cancer 75:1426–1432, 1995

    Google Scholar 

  7. Champion G, Richter JE, Vaezi MF, Singh S, Alexander R: Duodenogastroesophageal reflux: relationship to pH and importance in Barrett's esophagus. Gastroenterology 107:747–754, 1994

    Google Scholar 

  8. Kauer WK, Peters JH, DeMeester TR, Ireland AP, Bremner CG, Hagen JA: Mixed reflux of gastric and duodenal juices is more harmful to the esophagus than gastric juice alone. The need for surgical therapy re-emphasized. Ann Surg 222:525–531, 1995

    Google Scholar 

  9. Vaezi MF, Richter JE: Synergism of acid and duodenogastroesophageal reflux in complicated Barrett's esophagus. Surgery 117:699–704, 1995

    Google Scholar 

  10. Fein M, Ireland AP, Ritter MP, Peters JH, Hagen JA, Bremner CG, DeMeester TR: Duodenogastric reflux potentiates the injurious effects of gastroesophageal reflux. J Gastrointest Surg 1:27–33, 1997

    Google Scholar 

  11. Stein HJ, Kauer WK, Feussner H, Siewert JR: Bile reflux in benign and malignant Barrett's esophagus: effect of medical acid suppression and Nissen fundoplication. J Gastrointest Surg 2:333–340, 1998

    Google Scholar 

  12. Devesa SS, Blot WJ, Fraumeni JFJ: Changing patterns in the incidence of esophageal and gastric carcinoma in the United States. Cancer 83:2049–2053, 1998

    Google Scholar 

  13. Lagergren J, Bergstrom R, Lindgren A, Nyren O: Symptomatic gastroesophageal reflux as a risk factor for esophageal adenocarcinoma. N Engl J Med 340:825–831, 1999

    Google Scholar 

  14. Bechi P, Balzi M, Becciolini A, Amorosi A, Scubla E, Giache V, Mazzanti R, Tonelli P, Cortesini C: Gastric cell proliferation kinetics and bile reflux after partial gastrectomy. Am J Gastroenterol 86:1424–1432, 1991

    Google Scholar 

  15. Eriksson B, Emas S, Jacobsson H, Larsson SA, Samuelsson K: Comparison of gastric aspiration and HIDA scintigraphy in detecting fasting duodenogastric bile reflux. Scand J Gastroenterol 23:607–610, 1988

    Google Scholar 

  16. Fuchs KH, Hinder RA, DeMeester TR, Stein HJ, Barlow AP, Gupta NC: Computerized identification of pathologic duodenogastric reflux using 24-hour gastric pH monitoring. Ann Surg 213:13–20, 1991

    Google Scholar 

  17. Bechi P, Pucciani F, Baldini F, Cosi F, Falciai R, Mazzanti R, Castagnoli A, Passeri A, Boscherini S: Long-term ambulatory enterogastric reflux monitoring. Validation of a new fiberoptic technique. Dig Dis Sci 38:1297–1306, 1993

    Google Scholar 

  18. Fein M, Fuchs KH, Bohrer T, Freys SM, Thiede A: Fiberoptic technique for 24-hour bile reflux monitoring: standards and normal values for gastric monitoring. Dig Dis Sci 41:216–225, 1996

    Google Scholar 

  19. Byrne JP, Romagnoli R, Bechi P, Attwood SE, Fuchs KH, Collard JM: Duodenogastric reflux of bile in health: the normal range. Physiol Meas 20:149–158, 1999

    Google Scholar 

  20. Romagnoli R, Collard JM, Bechi P, Salizzoni M: Gastric symptoms and duodenogastric reflux in patients referred for gastroesophageal reflux symptoms and endoscopic esophagitis. Surgery 125:480–486, 1999

    Google Scholar 

  21. Collard JM, Romagnoli R: Roux-en-Y jejunal loop and bile reflux. Am J Surg 179:298–303, 2000

    Google Scholar 

  22. Gutschow CA, Collard JM, Romagnoli R, Michel JM, Salizzoni M, Holscher AH: Bile exposure of the denervated stomach as an esophageal substitute. Ann Thorac Surg 71:1786–1791, 2001

    Google Scholar 

  23. Marshall RE, Anggiansah A, Owen WA, Manifold DK, Owen WJ: The extent of duodenogastric reflux in gastro-oesophageal reflux disease. Eur J Gastroenterol Hepatol 13:5–10, 2001

    Google Scholar 

  24. Barrett MW, Myers JC, Watson DI, Jamieson GG: Dietary interference with the use of Bilitec to assess bile reflux. Dis Esophagus 12:60–64, 1999

    Google Scholar 

  25. Vaezi MF, Richter JE: Role of acid and duodenogastroesophageal reflux in gastroesophageal reflux disease. Gastroenterology 111:1192–1199, 1996

    Google Scholar 

  26. Fuchs KH, Maroske J, Fein M, Tigges H, Ritter MP, Heimbucher J, Thiede A: Variability in the composition of physiologic duodenogastric reflux. J Gastrointest Surg 3:389–396, 1999

    Google Scholar 

  27. Thomas H, Wilhelm L, Petermann J, Rosenbaum KD, Lorenz D: Simultane Langzeitmessung des duodenogastralen Refluxes und der gastroduodenalen Motilität. Chirurg 68:618–623, 1997

    Google Scholar 

  28. Krönert T, Kahler G, Adam G, Scheele J: Fiberoptische Messungen mit einer Bilitec-Sonde zur Quantifizierung des Gallerefluxes nach aboraler Magenresektion. Zentralbl Chir 123:239–244, 1998

    Google Scholar 

  29. Wilson P, Jamieson JR, Hinder RA, Anselmino M, Perdikis G, Ueda RK, DeMeester TR: Pathologic duodenogastric reflux associated with persistence of symptoms after cholecystectomy. Surgery 117:421–428, 1995

    Google Scholar 

  30. Freedman J, Ye W, Naslund E, Lagergren J: Association between cholecystectomy and adenocarcinoma of the esophagus. Gastroenterology 121:548–553, 2001

    Google Scholar 

  31. Fuchs KH, Freys SM, Heimbucher J, Fein M, Thiede A: Pathophysiologic spectrum in patients with gastroesophageal reflux disease in a surgical GI-function laboratory. Dis Esophagus 8:211–217, 1995

    Google Scholar 

  32. Varga G, Fein M, Freys SM, Maroske J, Tigges H, Fuchs KH: Helicobacter pylori, bile reflux and gastric pH. Dig Dis Sci 2002 (in press)

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and permissions

About this article

Cite this article

Fein, M., Freys, S.M., Sailer, M. et al. Gastric Bilirubin Monitoring to Assess Duodenogastric Reflux. Dig Dis Sci 47, 2769–2774 (2002). https://doi.org/10.1023/A:1021069508731

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1023/A:1021069508731

Navigation