[Is alkaline gastroesophageal reflux an etiology for esophagitis?]

Alkaline gastroesophageal reflux (GER) is a controversial concept for the pathogenesis of non-infectious esophagitis in the absence of measurable acid GER. Excessive duodenogastric reflux, as it can be seen in antroduodenal motility disorders, seems to be prerequisite. Yet, bile acids, a marker for duodenal secretions, are more frequently found during acid than during alkaline GER. Moreover, it has not been possible to show mucosal toxicity by bile acids or trypsin when tested at concentrations similar to those measured in esophageal refluxate. It remains therefore questionable as to whether alkaline pH measured in the esophagus results from reflux of duodenal contents or if it is a sign of increased salivary or esophageal secretions, and if the analogy of gastritis and esophagitis secondary to biliary reflux is allowed. Alkaline GER more probably is an erroneous pathogenic concept for esophagitis which requires intensified antacid therapy.