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.