Bile acid concentrations in the refluxate of patients with reflux oesophagitis

Although reflux of bile acids has been implicated in the pathogenesis of reflux oesophagitis, attempts to document this in vivo have failed to detect more than trace amounts of bile acid in the oesophagus. To determine the bile acid composition of oesophageal refluxate, 45 patients with abnormal acid gastro-oesophageal reflux with oesophagitis and 10 controls had a size 14 Fr Salem sump tube positioned 5 cm above the lower oesophageal sphincter. Oesophageal contents were continuously aspirated and collected in aliquots every 2 h over 16 h. Fasting, postprandial, upright and supine (nocturnal) periods were assessed and total conjugated bile acids were measured by high pressure liquid chromatography with a sensitivity of 8 mumol/l. Conjugated bile acids were detected in 2 of 10 controls (maximum 40 mumol/l) and in 39 of 45 patients (87 per cent). Eleven patients had peak conjugated bile acid levels greater than 200 mumol/l, and these levels occurred exclusively during the supine (nocturnal) period. Median conjugated bile acid levels during daytime reflux were less than 20 mumol/l which was significantly lower than during nocturnal reflux (median 51 mumol/l, P less than 0.001). Conjugated bile acids are detected in the oesophagus of most patients with oesophagitis and may play a role in the pathogenesis of oesophagitis in some patients with nocturnal gastro-oesophageal reflux.