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[Biliary reflux can be a contributory cause of esophagitis]
J Freedman1, E Näslund, L Granström
1Enheten för kirurgi, Karolinska institutet vid Danderyds sjukhus, Stockholm.
Lakartidningen
|October 17, 1998
Summary
Duodenogastric reflux, involving bile salts and acids, can cause esophagitis. A new sensor shows increased esophageal bilirubin in patients with esophagitis, suggesting surgery may help those unresponsive to medication.
Area of Science:
- Gastroenterology
- Digestive Diseases
- Esophageal Pathophysiology
Background:
- Duodenogastric reflux (DGR) is increasingly recognized as a contributor to esophagitis.
- Components of duodenal content, including bile salts, trypsin, pepsin, and hydrochloric acid, can independently or synergistically induce esophageal inflammation.
- The role of DGR in refractory gastroesophageal reflux disease (GERD) and complicated esophagitis warrants further investigation.
Purpose of the Study:
- To investigate the role of duodenogastric reflux in the pathogenesis of esophagitis.
- To evaluate the utility of a novel fiber-optic sensor for measuring duodenal content in the esophagus.
- To explore the implications of DGR for treatment strategies in patients with esophagitis, particularly those with refractory symptoms or complications.
Main Methods:
- Utilized the Bilitech 2000, a fiber-optic sensor designed to detect bilirubin in the distal esophagus, providing 24-hour monitoring.
- Correlated esophageal bilirubin levels with the presence and severity of esophagitis.
- Examined the association between elevated esophageal bilirubin and specific complications such as esophageal stricture, ulceration, and Barrett's esophagus.
Main Results:
- Increased levels of esophageal bilirubin were observed in patients diagnosed with esophagitis.
- A particularly pronounced elevation in esophageal bilirubin was noted in patients with complicated esophagitis, including those with strictures, ulcers, or Barrett's esophagus.
- The findings suggest a potential link between increased duodenogastric reflux and the lack of response to proton pump inhibitor therapy in some reflux patients.
Conclusions:
- Duodenogastric reflux is a significant factor in the development and progression of esophagitis.
- The Bilitech 2000 sensor provides a valuable tool for quantifying duodenal content exposure in the esophagus.
- Surgical interventions, such as fundoplication or biliary diversion, may be effective treatment options for esophagitis patients with significant duodenogastric reflux, especially those unresponsive to medical management or with complications.