S. Fiorucci et al., CIRCADIAN VARIATIONS IN GASTRIC-ACID AND PEPSIN-SECRETION AND INTRAGASTRIC BILE-ACID IN PATIENTS WITH REFLUX ESOPHAGITIS AND IN HEALTHY CONTROLS, The American journal of gastroenterology, 90(2), 1995, pp. 270-276
Objectives: Duodenogastric reflux is a physiological phenomenon in bot
h fasting and postprandial state. Because this suggests that bile acid
s may reflux into the esophagus together with the acid in patients wit
h reflux esophagitis, we investigated the circadian variations of acid
and pepsin secretion and intragastric bile acid concentrations in 25
patients with reflux esophagitis and in 15 healthy controls. Methods:
Between-meal, nocturnal gastric and meal-stimulated acid and pepsin se
cretion and bile acid concentrations were measured by continuous gastr
ic aspiration and intragastric titration. Results: Bile acids were fou
nd in 85 and 59% of gastric samples (p < 0.05). Intragastric bile acid
concentrations were 6-8-fold higher in esophagitis patients than cont
rols during the day. Approximately 10% of gastric samples from reflux
esophagitis patients had a pH greater than 7, and all contained more t
han 500 mu mol/L bile acids. Bile acids and pepsin were simultaneously
revealed in 98% of the gastric samples from patients with reflux esop
hagitis,vith pH less than 4. Mean daily acid output (meal excluded) av
eraged 3.5 +/- 0.1 in healthy subjects and 2.7 +/- 0.2 mmol/30 minutes
in esophagitis patients (p < 0.05); meal-induced acid secretions were
similar. Total (24-h) acid secretion averaged 192.3 +/- 12.4 and 162.
4 +/- 10.5 mmol/24 h (p < 0.05). There were no differences in the dail
y pepsin output. Conclusions: Our data indicate that almost all ''acid
'' gastroesophageal refluxes should be considered as ''mixed'' refluxe
s. Because bile acids are found in the stomach irrespective of whether
the environment was acid or alkaline, pa-metry provides no useful inf
ormation on the pattern of duodenogastric reflux into the esophagus. V
ariability in the composition of the gastroesophageal refluxate may ex
plain why the severity of esophageal lesions differs in patients with
similar pattern of acid refluxes.