Technical aspects and clinical indications of 24-hour intragastric bile monitoring

Bilitec 2000 is a new device which spectrophotometrically detects the prese nce of bilirubin in the refluxate. It is, up to date, the;only method able to monitor for 24 hours the exposure time of esophageal and/or gastric muco sa to bilirubin-containing reflux. From the technical point of view, a part icularly relevant aspect is the necessity of associating pH and Bilitec mon itorings. The reason why is that, even in the stomach where Bilitec itself is adequate for assessing the exposure time to duodenogastric reflux, the d amaging capability of the different components of reflux strictly depends u pon pH. The most correct position inside the stomach for gastric monitoring is the 5cm-below-the-LES-distal-border-position. The diet needs to be stan dardized in order to avoid false positive results due to the ingestion of f oods with absorption close to bilirubin absorption. Ranges of normality wil l soon be available from a collaborative European Study. At variance with t he indications for esophageal monitoring which are wide (the same as for pH -monitoring), indications for gastric Bilitec monitoring are represented on ly by severe dyspeptic symptoms possibly related to duodenogastric reflux. An antrum-confined C gastritis in the absence of history of consumption of gastro-lesive drugs strongly suggests the possibility of duodenogastric ref lux. In this case, Bilitec monitoring can provide further evidence by measu ring the time of exposure of the gastric mucosa to reflux.