Does duodenal juice reflux into the esophagus of patients with complicated GERD? evaluation of a fiberoptic sensor for bilirubin

Kauer, W. K. H.; Burdiles, Patricio; Ireland, Adrian P.; Clark, Geoffrey W.B.; Peters, Jeffrey H.; Bremner, Cedric G.; DeMeester, Tom R.

doi:10.1016/s0002-9610(99)80116-0

Cited by 119 publications

(55 citation statements)

References 11 publications

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“…21 Esophageal exposure to duodenal juice was measured using a fiberoptic probe designed to detect bilirubin by spectrophotometry at 453 nm, the specific wavelength for absorption of bilirubin (Bilitec 2000, Medtronic Synectics, Shoreview, MN, USA). 22 The probe was passed transnasally and positioned at the same level as the pH electrode. Twenty-four-hour absorbance data were recorded on a portable optoelectric data logger and analyzed with a software program (Multigram, Gastrosoft, Irving, TX, USA).…”

Section: Manometrymentioning

confidence: 99%

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Hiatal Hernia, Lower Esophageal Sphincter Incompetence, and Effectiveness of Nissen Fundoplication in the Spectrum of Gastroesophageal Reflux Disease

Lord

DeMeester

Peters

et al. 2009

Journal of Gastrointestinal Surgery

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115

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Background and Aims Gastroesophageal reflux disease (GERD) is a spectrum of disease that includes nonerosive reflux disease (NERD), erosive reflux disease (ERD), and Barrett's esophagus (BE). Treatment outcomes for patients with different stages have differed in many studies. In particular, acid suppressant medication therapy is reported to be less effective for treating patients with NERD and Barrett's esophagus. The aims of this study were to investigate (1) the role of mechanical factors including hiatal hernia and lower esophageal sphincter (LES) competence in the spectrum of GERD and (2) outcomes of Nissen fundoplication. Methods From the records of patients who had undergone laparoscopic Nissen fundoplication after an abnormal pH study, we identified 50 symptomatic consecutive patients with each of the GERD stages: (1) NERD, (2) mild ERD, defined as esophagitis that was healed with acid suppression therapy, (3) severe ERD, defined as esophagitis that persisted despite medical therapy, and (4) BE. Exclusion criteria were normal distal esophageal acid exposure, esophageal pH monitoring performed elsewhere, antireflux surgery less than 1 year previously or previous fundoplication, and a named esophageal motility disorder or distal esophageal low amplitude hypomotility. Patients who could not be contacted for the study were also excluded. All patients completed a detailed preoperative questionnaire; underwent preoperative upper gastrointestinal endoscopy, stationary manometry, and distal esophageal pH monitoring; and were interviewed at least 1 year after operation. Results One hundred sixty patients meeting the entry criteria were studied. The mean follow-up period was 36.7 months. The only significant preoperative symptom difference was that patients with BE had more moderately severe or severe dysphagia compared to patients with NERD. Patients with severe ERD or BE had a significantly higher prevalence of hiatal hernia, lower LES pressures, and more esophageal acid exposure. Hiatal hernia and hypotensive LES were present in most patients with severe ERD or BE but in only a minority of patients with NERD or mild ERD. Surgical therapy resulted in similarly excellent symptom outcomes for patients in all GERD categories. Conclusions Compared to mild ERD and NERD, severe ERD and BE are associated with significantly greater loss of the mechanical antireflux barrier as reflected in the presence of hiatal hernia and LES measurements. Restoration of the antireflux barrier and hernia reduction by laparoscopic Nissen fundoplication provides similarly excellent symptom control in all patients.

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Section: Manometrymentioning

confidence: 99%

“…The upper limit of the normal range for bilirubin exposure was 1.7% of the total time above an absorbance threshold of 0.2. 22 Patient diets were restricted to three meals per day with no foods with an absorbance similar to that of bilirubin.…”

Section: Manometrymentioning

confidence: 99%

Hiatal Hernia, Lower Esophageal Sphincter Incompetence, and Effectiveness of Nissen Fundoplication in the Spectrum of Gastroesophageal Reflux Disease

Lord

DeMeester

Peters

et al. 2009

Journal of Gastrointestinal Surgery

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115

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show abstract

“…Recent investigations have highlighted the importance of symptomatic gastro-esophageal reflux as a risk factor (12). It has been suggested that reflux of duodenal contents, bile, and gastric acid are also important in the pathogenesis of gastroesophageal reflux disease (13,14). However, not all patients with reflux develop Barrett's esophagus, and other factors must also be important.…”

Section: Epidemiology and Etiology Of Esophageal Adenocarcinoma And Bmentioning

confidence: 99%

Biomarkers of Esophageal Adenocarcinoma and Barrett’s Esophagus

2004

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The rising incidence and poor prognosis of esophageal adenocarcinoma in the Western world have intensified research efforts into earlier methods of detection of this disease and its relationship to Barrett's esophagus. The progression of Barrett's esophagus to adenocarcinoma has been the focus of particular scrutiny, and a number of potential tissue and serum-based disease biomarkers have emerged. The epidemiology and pathogenesis of esophageal adenocarcinoma are outlined. Tissue biomarkers allowing risk stratification of Barrett's are reviewed as well as strategies currently being used to discover novel biomarkers that will facilitate the early detection of esophageal adenocarcinoma. Finally, the uses of biomarkers as predictive tests for targeted treatments and as surrogate endpoints in chemoprevention trials are considered.

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“…The association between duodenal reflux and the severity of esophagitis was examined by Kauer et al (1995b) who used a fiberoptic probe to detect bile as a marker of duodenal refluxate. They found that patients with erosive esophagitis and Barrett's metaplasia had increased exposure to duodenal juice at a normal esophageal pH.…”

Section: Role Of Duodenal Reflux In Esophagitismentioning

confidence: 99%

Review Article; Duodeno-Gastro-Esophageal Reflux Combined and Isolated

Nasr¹

2013

American Medical Journal

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Barrett's esophagus is the chief risk factor for esophageal adenocarcinoma. Reflux of gastric acid has long been related to the development of esophagitis and Barrett's esophagus, but the role of duodenal contents is controversial. We review the literature on the role of duodenal contents in the development of esophagitis, Barrett's esophagus and adenocarcinoma in addition to the role of acid suppressant therapy in the development or prevention of these changes. A computer-based search of the literature using the terms "Bilirubin, Barrett, Bile Reflux, duodeno-gastric reflux and oesophagus/esophagus" was performed. The role of bile and other constituents of duodenal refluxate were examined. Techniques for identifying nonacid reflux were also reviewed, as were the role of pH, medication and surgery in modulating disease severity. Complicated Barrett's esophagus is associated with increased exposure to gastric and duodenal refluxate. Biological effect of bile acids depends on the conjugation status, the pH of the milieu and the pKa of bile acids. While Proton Pump Inhibitors reduce the levels of DGER, they also produce changes in gastric and lower esophageal pH that activate different bile acids at different pH levels resulting in unexpected injury. Conjugated bile acids are harmful in acidic environment while unconjugated bile acids are harmful at neutral pH environment. An overlap of toxicity among conjugated and unconjugated bile acids occurs between strongly acidic and neutral pH levels. Normalisation of gastric and duodenal refluxate should ideally be the goal of treatment.

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Does duodenal juice reflux into the esophagus of patients with complicated GERD? evaluation of a fiberoptic sensor for bilirubin

Cited by 119 publications

References 11 publications

Hiatal Hernia, Lower Esophageal Sphincter Incompetence, and Effectiveness of Nissen Fundoplication in the Spectrum of Gastroesophageal Reflux Disease

Hiatal Hernia, Lower Esophageal Sphincter Incompetence, and Effectiveness of Nissen Fundoplication in the Spectrum of Gastroesophageal Reflux Disease

Biomarkers of Esophageal Adenocarcinoma and Barrett’s Esophagus

Review Article; Duodeno-Gastro-Esophageal Reflux Combined and Isolated

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