Importance of duodeno-gastro-esophageal reflux in the medical outpatient practice

BACKGROUND/AIMS: The role of acid and duodeno-gastro-esophageal reflux (DGE R), also termed bile reflux, in esophageal mucosal injury is controversial. Several recent developments, especially availability of the recent bilirub in monitoring device (Bilitec), have resulted in clarifications in this are a. In order to better understand the role of acid and DGER in esophageal mu cosal injury, we summarized the recent pulibcations in this area. METHODOLOGY: Review of published medical literature (MEDLINE) on the clinic al consequence of esophageal exposure to gastric acid or DGER. RESULTS: Recent data suggest that esophageal pH monitoring and pH >7 is a p oor marker for reflux of duodenal contents into the esophagus. DGER in non- acidic environments (i.e., partial gastrectomy patients) may cause symptoms but does not cause esophageal mucosal injury. Acid and duodenal contents u sually reflux into the esophagus simultaneously, and may be contributing to the development of Barrett's metaplasia and possibly adenocarcinoma. Proto n pump inhibitors decrease acid and DGER by reducing intragastric volume av ailable for reflux and raising intragastric pH. The promotility agent cisap ride decreases DGER by increasing LES pressure and improving gastric emptyi ng. CONCLUSIONS: 1) The term "alkaline reflux" is a misnormer and should no lon ger be used in referring to reflux of duodenal contents. 2) Bilitec is the method of choice in detecting DGER and should always be used simultaneously with esophageal pH-monitoring for acid reflux. 3) DGER alone is not injuri ous to esophageal mucosa, but can result in significant esophageal mucosal injury when combined with acid reflux. 4) Therefore, controlling esophageal exposure to acid reflux by using proton pump inhibitors also eliminates th e potentially damaging effect of DGER.