Differential Bile Acid Detection in Refractory GERD Patient Saliva Using a Simple and Sensitive Liquid Chromatography...

Area of Science:

• Gastroenterology
• Analytical Chemistry
• Biochemistry

Background:

• Gastroesophageal reflux disease (GERD) affects millions globally.
• Proton pump inhibitors (PPIs) are the standard treatment for GERD.
• Refractory GERD, where symptoms persist despite PPI treatment, requires alternative diagnostic approaches.

Purpose of the Study:

• To measure bile acids in human saliva.
• To differentiate quantitative differences in bile acid levels between refractory GERD patients, PPI-controlled GERD patients, and healthy volunteers.
• To explore the potential of saliva bile acid analysis for diagnosing biliary reflux in refractory GERD.

Main Methods:

• Analysis of human saliva samples from two studies.
• Utilized ultra-performance liquid chromatography tandem mass spectrometry (UPLC-MS/MS) for sensitive bile acid detection.
• Compared bile acid concentrations in healthy subjects, PPI-controlled GERD patients, and refractory GERD patients.

Main Results:

• In a pilot study, saliva bile acid levels transiently increased post-meal in healthy and PPI-controlled GERD groups.
• In an exploratory study, refractory GERD patients exhibited significantly higher total saliva bile acid concentrations compared to healthy volunteers and PPI-controlled GERD patients (P=0.0181).
• No significant differences were observed between healthy subjects and PPI-controlled GERD patients in the pilot study.

Conclusions:

• Bile acids can be accurately quantified in human saliva using UPLC-MS/MS.
• Elevated saliva bile acid levels may indicate underlying biliary reflux in refractory GERD.
• This salivary assay presents a potential non-invasive tool for evaluating biliary reflux in GERD management.