FIBEROPTIC TECHNIQUE FOR 24-HOUR BILE REFLUX MONITORING - STANDARDS AND NORMAL VALUES FOR GASTRIC MONITORING

Physiologic bile reflux was assessed in 27 in vivo test with healthy v olunteers to define a standardized protocol and normal values for 24-h our enterogastric bile reflux monitoring (protocol with supine, uprigh t, and meal phases and a free diet avoiding alcohol, smoking, and coff ee, evaluation with different thresholds of absorbance units: 0.14, 0. 25). In vitro tests with bile-sodium solutions demonstrated a linear d ependence of absorbance for bilirubin up to 600 mu mol/liter (range of the fiberoptic device: 0.0-1.0). Fluids and food might interfere with absorbances below 0.25 (exception: coffee). In vivo bile often remain s in the stomach for more than 1 hr; these events were defined as refl ux episodes. The upper limits for physiologic bile reflux are a percen tage of total time of bile reflux of 28.2% and an average absorbance d uring a reflux episode of 0.62 (95th percentile with threshold 0.25). Comparing bile with pH monitoring (absorbance > 0.25 and/or pH > 4), a n increase of bilirubin was found most frequently with constant pH (45 %) or an increase of pH with constant bilirubin (36%). The hypothesis was drawn that bile and duodenal or pancreatic secretions may separate ly contribute to duodenogastric reflux.