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Bile and acid reflux in the pathogenesis of reflux oesophagitis in children

Mizu Jiang1, Jie Chen, Feibo Chen

  • 1Department of Gastroenterology, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China. mizu@zju.edu.cn

Journal of Paediatrics and Child Health
|February 12, 2009
PubMed

Insights

In children, mixed acid and bile reflux is the primary cause of reflux oesophagitis (RE). Isolated bile reflux also contributes to RE, particularly in cases without acid reflux.

Area of Science:

  • Pediatric Gastroenterology
  • Gastrointestinal Motility Disorders
  • Esophageal Diseases

Background:

  • Gastro-oesophageal reflux symptoms are common in children.
  • The specific roles of acid and bile reflux in pediatric reflux oesophagitis (RE) require further elucidation.

Purpose of the Study:

  • To investigate the contribution of both bile and acid reflux to the development of reflux oesophagitis in pediatric patients.

Main Methods:

  • Simultaneous 24-hour esophageal pH and bilirubin monitoring were performed in 44 children (aged 5-17) with gastro-oesophageal reflux symptoms.
  • Esophageal mucosal biopsies were obtained via gastro-endoscopy for analysis.

Main Results:

  • Mixed acid and bile reflux was the most common pattern (36.4%), followed by isolated acid reflux (22.7%) and isolated bile reflux (22.7%).
  • Patients with RE showed significantly higher parameters of acid reflux compared to those with non-erosive reflux disease (NERD).
  • Acid reflux was present in 76.9% of RE cases versus 33.3% of NERD cases (P < 0.01).

Conclusions:

  • Mixed reflux is the predominant form of reflux causing esophageal mucosal injury in children.
  • Isolated bile reflux plays a role in RE development, specifically in patients without concurrent acid reflux.
Abstract

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