THE RELATIONSHIP BETWEEN ACID AND BILE REFLUX AND SYMPTOMS IN GASTROESOPHAGEAL REFLUX DISEASE

Background-The role of bile in the genesis of oesaphageal symptoms and disease is incompletely understood. A new method of ambulatory bile m onitoring may help to define this role. Aims-To establish the relation ship between symptom events and acid and bile reflux episodes. Patient s-59 consecutive patients presenting for further investigation of gast rooesophageal reflux disease. Methods-All patients underwent combined ambulatory pH and bile monitoring. For each patient, a symptom index ( SI) was calculated in relation to both acid reflux and bile reflux epi sodes, Results-Patients were divided into those without (group 1, n=21 ) and those with (group 2, n=38) acid reflux, A total of 394 symptoms were identified in 59 patients. In group 1, there were fewer symptom e vents per patient (meals 4.1) than group 2 (mean 8.1). Twenty three pe r cent of symptom events were associated with acid reflux in group 1 a nd 41% in group 2. Only 6% of symptom events in both groups were relat ed to bile reflux, In group 1 both the acid and bile related SI score were low. In group 2 the bile related SI score was law, but the acid r elated SI score was high. Conclusions-Symptoms are much more often rel ated to acid reflux than bile reflux. Bile reflux does not seem to be a major factor in producing oesophageal symptoms.