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Fiberoptic technique for 24-hour bile reflux monitoring

Standards and normal values for gastric monitoring

  • Diagnostic and Interventional Techniques
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Abstract

Physiologic bile reflux was assessed in 27in vivo test with healthy volunteers to define a standardized protocol and normal values for 24-hour enterogastric bile reflux monitoring (protocol with supine, upright, and meal phases and a free diet avoiding alcohol, smoking, and coffee, evaluation with different thresholds of absorbance units: 0.14, 0.25).In vitro tests with bile-sodium solutions demonstrated a linear dependence of absorbance for bilirubin up to 600 μmol/liter (range of the fiberoptic device: 0.0–1.0). Fluids and food might interfere with absorbances below 0.25 (exception: coffee).In vivo bile often remains in the stomach for more than 1 hr; these events were defined as reflux episodes. The upper limits for physiologic bile reflux are a percentage of total time of bile reflux of 28.2% and an average absorbance during a reflux episode of 0.62 (95th percentile with threshold 0.25). Comparing bile with pH monitoring (absorbance>0.25 and/or pH>4), an increase of bilirubin was found most frequently with constant pH (45%) or an increase of pH with constant bilirubin (36%). The hypothesis was drawn that bile and duodenal or pancreatic secretions may separately contribute to duodenogastric reflux.

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References

  1. Ilei T, Whitfield PF, Boulos PB, Hobsley M: Gastric outlet loss and enterogastric reflux after gastrectomy. Br J Surg 75:272–274, 1988

    Google Scholar 

  2. Robles-Campos R, Lujan-Mompean JA, Parrilla-Paricio P, Bermejo-Lopez J, Liron-Ruiz R, Torralba-Martinez JA, Morales-Cuenca G, Molina-Martinez JA: Role ofHelicobacter pylori infection and duodenogastric reflux in pathogenesis of alkaline reflux gastritis after gastric operations. Surg Gynecol Obstet 176:594–598, 1993

    Google Scholar 

  3. Werner B: Historische Daten and Betrachtungen zur Entwicklung der Refluxkrankheiten des Magens.In Refluxkrankheit des Magens. V Schumpelick, F Begemann, B Werner (eds), Stuttgart, Enke. 1985, pp 3–15

    Google Scholar 

  4. Müller-Lissner SA: Ist duodenogastraler Reflux pathogen? Z Gastroenterol 26:637–642, 1988

    Google Scholar 

  5. Ritchie WP: Alkaline reflux gastritis. Ann Surg 82:288–298, 1980

    Google Scholar 

  6. Schlindlbeck NE, Lippert M, Heinrich C, Müller-Lissner SA: Intragastric bile acid concentration in critically ill, artificially ventilated patients. Am J Gastroenterol 84:624–628, 1989

    Google Scholar 

  7. Salomoni M, Zuccato E, Granelli P, Montorsi W, Doldi SB, Germiniani R, Mussini E: Effect of bile salts on carbonic anhydrase from rat and human gastric mucosa. Scand J Gastroenterol 24:28–32, 1989

    Google Scholar 

  8. Cabrol J, Navarro X, Sancho J, Simo-deu J, Segura R: Bile reflux in postoperative alkaline reflux gastritis. Ann Surg 2:239–243, 1990

    Google Scholar 

  9. 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 

  10. Xynos E, Vassilakis JS, Fountos A, Pechlivanides G, Karkavitsas N: Enterogastric reflux after various types of antiulcer gastric surgery: Quantification by99mTc-HIDA scintigraphy. Gastroenterology 101:991–998, 1991

    Google Scholar 

  11. Waring JP, Legrand J, Chinichian A, Sanowski RA: Duodenogastric reflux in patients with Barrett's esophagus. Dig Dis Sci 35:759–762, 1990

    Google Scholar 

  12. Bremner CG, Mason RJ: “Bile” in the esophagus. Br J Surg 80:1374–1376, 1993

    Google Scholar 

  13. Bechi P, Falciai R, Baldini F, Cosi F, Pucciani F, Boscherini S: A new fiber optic sensor for ambulatory entero-gastric reflux detection.In Fiber Optic Medical and Fluorescent Sensors and Applications. A Katzir (ed). Bellingham, Proc SPIE 1648, 1992, pp 130–135

  14. 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 

  15. Fimmel CJ, Etienne A, Cilluffo T, v Ritter C, Gasser T, Rey J-P, Caradonna-Moscatelli P, Sabbatini F, Pace F, Bühler HW, Bauerfeind P, Blum AL: Long-term ambulatory gastric pH monitoring: Validation of a new method and effect of H2-antagonists. Gastroenterology 88:1842–1851, 1985

    Google Scholar 

  16. Emde C, Garner AC, Blum AC: Technical aspects of intraluminal pH-metry in man: Current status and recommendations. Gut 28:1177–1188, 1987

    Google Scholar 

  17. Fuchs KH, DeMeester TR, Hinder RA, 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 

  18. Wahlefeld AW, Herz G, Bernt E: Scand J Clin Lab Invest 29(suppl. 126):abstract 11–12, 1972

    Google Scholar 

  19. Bechi P: Fiberoptic measurement of “alkaline” gastroesophageal reflux: technical aspects and clinical indications. Dis Esophagus 7:131–138, 1994

    Google Scholar 

  20. Richter JE: Normal values for esophageal manometry.In Esophageal Motility Testing. DO Castell, JE Richter, CB Dalton (eds). New York, Elsevier Science Publishing. 1987. pp 79–90

    Google Scholar 

  21. DeMeester TR, Stein H, Fuchs K-H: Diagnostic studies in the evaluation of the esophagus: Physiologic diagnostic studies.In Shackelford's Surgery of the Alimentary Tract. 3rd ed. MB Orringer (ed). Philadelphia. WB Saunders, 1991, pp 94–102

    Google Scholar 

  22. Fuchs KH, Selch A, Freys SM, DeMeester TR: Gastric acid secretion and gastric pH measurement in peptic ulcer disease. Probl Gen Surg 9:138–151, 1992

    Google Scholar 

  23. Stein HJ, Kraemer SJM, Feussner, Siewert JR: Quantifizierung des intestino-ösophagealen Refluxes mit einer fiberoptischen Bilirubin-Me\sonde. Z Gastroenterol 32:247–251, 1994

    Google Scholar 

  24. Vaezi MF, Lacamera RG, Richter JE: Validation studies of Bilitec 2000: An ambulatory duodenogastric reflux monitoring system. Am J Physiol 267:G1050-G1057, 1994

    Google Scholar 

  25. Kauer WKH, Burdiles P, Ireland AP, Clark GWB, Peters JH, Bremner CG, DeMeester TR: Does duodenal juice reflux into the esophagus of patients with complicated GERD? Evaluation of a fiberoptic sensor for bilirubin. Am J Surg 169:98–104, 1995

    Google Scholar 

  26. Mattioli S, Pilotti V, Felice V, Lazzari A, Zannoli R, Bacchi ML, Loria P, Tripodi A, Gozzetti G: Ambulatory 24-hr pH monitoring of esophagus, fundus and antrum. Dig Dis Sci 35:929–938, 1990

    Google Scholar 

  27. Mattioli S, Felice V, Pilotti V, Bacchi ML, Pastina M, Gozzetti G: Indications for 24-hr gastric pH monitoring with single and multiple probes in clinical research and practice. Dig Dis Sci 37:1793–1801, 1992

    Google Scholar 

  28. Keane FB, Dimagno EP, Malagelada J-R: Duodenogastric reflux in humans: Its relation to fasting antroduodenal motility and gastric, pancreatic and biliary secretion. Gastroenterology 81:726–731, 1981

    Google Scholar 

  29. Hausken T, Odegaard S, Matre K, Berstad A: Antroduodenal motility and movements of luminal contents studied by duplex sonography. Gastroenterology 102:1583–1590, 1992

    Google Scholar 

  30. Hostein J, Bost R: Intragastric pH monitoring is not suitable for diagnosis of duodenogastric reflux. Dig Dis Sci 36:1341–1343, 1991

    Google Scholar 

  31. Müller-Lissner SA, Fraass C: Dissociation of duodenogastric marker reflux and bile salt reflux. Dig Dis Sci 30:733–738, 1985

    Google Scholar 

  32. Champion G, Richter JE, Vaezi M, Singh S, Alexander R: Duodenogastroesophageal reflux: Relationship to pH and importance in Barrett's esophagus. Gastroenterology 107:747–757, 1994

    Google Scholar 

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Authors and Affiliations

  1. Department of Surgery, University of Würzburg, Josef-Schneider-Str. 2, 97080, Würzburg, Germany

    Martin Fein MD, PhD, Karl-Hermann Fuchs MD, Thomas Bohrer, Stephan M. Freys MD & Arnulf Thiede MD

Authors
  1. Martin Fein MD, PhD
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  2. Karl-Hermann Fuchs MD
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  3. Thomas Bohrer
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  4. Stephan M. Freys MD
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  5. Arnulf Thiede MD
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Fein, M., Fuchs, KH., Bohrer, T. et al. Fiberoptic technique for 24-hour bile reflux monitoring. Digest Dis Sci 41, 216–225 (1996). https://doi.org/10.1007/BF02208607

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  • DOI: https://doi.org/10.1007/BF02208607

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