Fasting intragastric total bile acid concentration in patients with gastroduodenal ulcer

It has been suggested that bile reflux is an important factor in the development of gastric ulcers and even duodenal ulcers. In this study we measured the fasting total bile acid concentration (BAC) in gastric juice and used it to represent the bile reflux. A total of 110 subjects were collected consecutively, including 55 panendoscopically normal subjects as controls, 34 patients with duodenal ulcers (DU), 15 patients with gastric ulcers (GU) and 6 patients with both gastric and duodenal ulcers (GDU). The results showed a wide individual variation of intragastric bile acid concentration (BAC) in normal subjects and nearly 95% of them had concentrations below 160 mumol/L. Normal subjects above 40 years of age had significantly lower BACs than those under 40 years. There was no sex influence on BACs. In the subgroup above 40 years of age, DU and GDU patients had significantly higher BACs than normal controls and GU patients. We conclude that: (1) bile reflux is a common phenomenon in normal subjects, being mostly mild; (2) bile reflux may become milder after 40 years of age; (3) bile reflux is not an important factor in the pathogenesis of gastric ulcers; and (4) duodenal ulcers may not enhance the duodenogastric reflux, except in patients over 40 years of age.