Diagnosis of incipient reflux esophagitis: a new test

Sensitivity and reliability of a new esophageal perfusion test was evaluated and compared with those of the standard hydrochloric acid (N/10 HCl) perfusion test. Sixty-four patients including 43 with biopsy-proven reflux esophagitis (group A) and 21 with negative esophageal biopsy and equivocal symptoms (Group B) had esophageal perfusion with N/10 HCl and with taurine bile salt conjugates in N/10 HCl (T-N/10 HCl) in a double-blind, randomized fashion. In group A, T-N/10 HCl perfusion led to 100% positive results as opposed to 70% with N/10 HCl perfusion. Moreover, response times were significantly shorter (9 +/- 4 min) and washout times longer (18 +/- 4 min) with T-N/10 HCl than with N/10 HCl perfusion (18 +/- 5 min, P less than .001; and 10 +/- 3 min, P less than .001, respectively). All (100%) group B patients had negative N/10 HCl perfusion tests, whereas eight (40%) had positive T-N/10 HCl tests. All patients with positive T-N/10 HCl tests improved with administration of antacids and bile salt binders, whereas none with negative T-N/10 HCl tests improved with such therapy. Accordingly, T-N/10 HCl perfusion was more sensitive than N/10 HCl perfusion for detection of reflux esophagitis. Since all biopsy-negative patients who responded to treatment normally reserved for reflux esophagitis had a positive T-N/10 HCl test, it is possible that this test was able to detect early incipient esophagitis, before histologic changes became apparent at biopsy.