SYNERGISM OF ACID AND DUODENOGASTROESOPHAGEAL REFLUX IN COMPLICATED BARRETTS-ESOPHAGUS

Background. The role of acid and duodenogastroesophageal reflux (DGER) in the development of complications in Barrett's esophagus is controv ersial. We characterized the esophageal reflux constituents in patient s with and without complications of Barrett's esophagus. Methods. Usin g a new fiber-optic system we studied 12 normal subjects (six male; me an age, 46 years) and 20 patients with Barrett's esophagus (17 male; m ean age, 58 years), nine with uncomplicated (seven male; mean age, 55 years) and 11 with complicated Barrett's esophagus (seven with strictu re, two with ulcer, and two with dysplasia; 10 male; mean age, 61 year s). Fasting gastric bile acid concentrations were measured. Twenty-Sou r-hour ambulatory acid and bilirubin measurements were obtained with t he fiber-optic system by using a glass electrode and fiber-optic senso r. The data were then analyzed for percent total time pH <4 and >7 and bilirubin absorbance >0.14%. Results. Percent times pH <4, bilirubin absorbance >0.14%, and fasting gastric bile acid concentrations were s ignificantly greater in patients with complicated Barrett's esophagus compared with patients with uncomplicated Barrett's esophagus with bot h being higher than the controls. Acid reflux paralleled bile reflux i n the two Barrett's esophagus groups (r = 0.44, p < 0.05), but percent time pH >7 did not differentiate between the two groups. Conclusions. (1) Patients with complicated Barrett's esophagus reflux significantl y greater amounts of both acid and duodenal contents than patients wit h uncomplicated Barrett's esophagus. (2) Complications in Barrett's es ophagus may be due to synergism between acid and bile rather than eith er constituent alone.