SPONTANEOUS BILE REFLUX IN THE ELDERLY

Duodenogastric bile reflux is common in postoperative stomach but has been reported in intact stomachs. Spontaneous bile reflux in the elder ly has not been studied before. This has been assessed in dyspeptic el derly and young patients. Total bile acid (TBA) levels and pH were mea sured in the samples of fasting gastric juice. Antral biopsies were ta ken for histological examination including Helicobacter pylori identif ication. TBA levels were significantly higher in elderly patients with gastritis in comparison to elderly and young normal groups. Only 10% of elderly patients with gastritis and 7% with gastric ulcer has abnor mal TBA (>1 mmol/1). There was some correlation between the pH and TBA but a significant proportion of elderly patients has pH >4 with a nor mal TBA. TBA levels were not significantly different in H. pylori +ve and H. pylori -ve patients. Nineteen elderly patients had evidence of reactive gastritis. Five of these patients had raised TBA levels with severe H. pylori infection. The remaining 15 patients had normal TBA. These patients were on NSAIDs and 4 of them had H. pylori infection. W e conclude that spontaneous bile reflux in the elderly is uncommon. Hy pochlorhydria which is observed in the elderly is not caused by alkali ne bile reflux. The main cause of reactive gastritis in the elderly is NSAIDs ingestion.