ASSESSMENT OF INTESTINO-ESOPHAGEAL REFLUX WITH A FIBEROPTIC BILIRUBINPROBE

Currently available methods to assess reflux of duodenal contents into the esophagus are cumbersome, unphysiologic, and inaccurate. The role of intestino-esophageal reflux has therefore been controversial. We a ssessed intestino-esophageal reflux using a new system which allows pr olonged intraesophageal measurement of bilirubin, the major pigment of bile. Measurements were made with a newly developed fiber-optic senso r electrode connected to a portable data processing unit (BILITEC 2000 , Synectics Medical Inc., Sweden). Light absorption was measured at th e absorption peak of bilirubin and a reference point. Studies were per formed in 9 subjects without esophagitis, 9 subjects with esophagitis and primary reflux disease and 7 subjects with erosive esophagitis aft er a total or subtotal gastrectomy. The fiberoptic electrode was place d 5 cm above the lower esophageal sphincter. In vitro studies showed l inear correlations between absorbance measurements obtained with the B ILITEC-unit and known bilirubin and bile acid concentrations, respecti vely (p < 0.01). Compared to both other groups, light absorption was m arkedly increased in the subjects who had esophagitis after a total or subtotal gastrectomy (p < 0.05) indicating severe biliary reflux. An increase in bilirubin absorption occurred particularly during the post prandial and supine periodes (p < 0.01). A Roux-en-Y biliary diversion procedure completely abolished bile reflux in 2 of these patients. Th ese data indicate that ambulatory 24-hour fiberoptic measurement of bi lirubin in the esophagus is feasible and allows quantitation of intest ino-esophageal reflux. Intestino-esophageal reflux occurs particularly during the postprandial period and the early morning hours in patient s who had a previous subtotal or total gastrectomy.