ALKALINE GASTROESOPHAGEAL REFLUX - A CAUS E OF ESOPHAGITIS

Alkaline gastroesophageal reflux (GER) is a controversial concept for the pathogenesis of non-infectious esophagitis in the absence of measu rable acid GER. Excessive duodenogastric reflux, as it can be seen in antroduodenal motility disorders, seems to be prerequisite. Yet, bile acids, a marker for duodenal secretions, are more frequently found dur ing acid than during alkaline GER. Moreover: it has not been possible to show mucosal toxicity by bile acids ol trypsin when tested at conce ntrations similar to those measured in esophageal refluxate. It remain s therefore questionable as to whether alkaline pH measured in the eso phagus results from reflux of duodenal contents or if it is a sign of increased salivary or esophageal secretions, and if the analogy of gas tritis and esophagitis secondary to biliary reflux is allowed. Alkalin e GER more probably is an erroneus pathogenic concept for esophagitis which requires intensified antacid therapy.