Bile Reflux into the Stomach and the Esophagus for Volunteers Older than 40 Years

Abstract

Background: An increased incidence of Barrett’s esophagus in cases with combined acidic and bile reflux is reported. The volunteers serving as controls in those studies were significantly younger than the patients. The aim of this study was to analyze bile reflux patterns of healthy volunteers aged comparably to patients with Barrett’s esophagus. Subjects and Methods: 19 older (8 f, 11 m; median age 51 years) (OV) and 20 younger (10 f, 10 m; median age 25 years) (YV) healthy volunteers without history of gastrointestinal disease or medication underwent simultaneous 24-hour pH and bile monitoring (Bilitec^®). All subjects consumed a special diet that did not interfere with bile measurements. Indicators for bile reflux in the stomach and esophagus: bilirubin probe absorption >0.25 in total measuring period (TM), upright position (excluding postprandial periods) (UP) and supine period (SP). Results: There were no differences between older and younger volunteers in pH monitoring. Comparing the periods of bilirubin exposure of the stomach, the median (lower and upper quartile) percentage of time was OV = 5.7% (1.0–15.0%) and YV = 3.5% (0.1–7.8%) respectively for TM (n.s.), OV = 3.1% (0.7–9.4%) and YV = 0.4% (0.0–7.1%) for UP (n.s.), and OV = 2.1% (0.2–16.7%) and YV = 5.9% (0.0–12.2%) respectively for SP (n.s.). In 10/19 older volunteers and in 18/20 younger volunteers, no reflux of bile into the esophagus was measured. However, 4 older volunteers presented bile reflux from 4.6 to 51% of the total measuring period in contrast to the younger group with a maximum of 1.3% of TM. Conclusion: No significant differences in bile reflux into the stomach were distinguishable between younger and older healthy volunteers, but older volunteers more frequently exhibited bile reflux into the esophagus.

Importance of duodenogastric reflux in gastro-oesophageal reflux disease

“…The amount of DGR in the controls was almost identical to the normal values reported by others 29 . An international multicentre study on DGR in healthy subjects reported a similar median value, but a higher 95th percentile, probably related to the fact that a liquid diet was given 27 .…”

Duodeno-Gastric-Esophageal Reflux—What is Pathologic? Comparison of Patients with Barrett’s Esophagus and Age-Matched Volunteers

“…The bile and pH probes were taped together and passed transnasally into the esophagus and stomach, as described in detail elsewhere 17. The upper tips of the probes were positioned 5 cm above the upper border of the lower esophageal sphincter as defined by esophageal manometry.…”

Measuring Duodeno-Gastric and Duodeno-Gastro-Esophageal Reflux in Clinical Practice: The Role of Age

“…The paper by Bollschweiler et al [11] demonstrates that upper limits of normal may be higher in subjects 1 40 years , which is likely to be the majority of the patients. It is unclear whether DGER exposure would be even higher in those older than 60 or 70 years.…”

“…In the present issue of Digestion , Bollschweiler et al [11] compared normal values for DGR and DGER exposure in younger and older asymptomatic volunteers . The authors found that older volunteers ( 1 40 years old) had higher DGER exposure compared to younger volunteers, but they reported no differences in DGR exposure.…”

“…It is unclear whether DGER exposure would be even higher in those older than 60 or 70 years. Furthermore, there is a major variability of normal ranges of esophageal DGER exposure across the literature, and dietary habits or restrictions have a major impact on DGER exposure values [7,11]. Clinicians should therefore be careful when considering to take major management decisions, like referral for surgery, on the basis of Bilitec ® studies.…”