ASSESSMENT OF COMBINED BILE-ACID AND PH PROFILES USING AN AUTOMATED SAMPLING DEVICE IN GASTROESOPHAGEAL REFLUX DISEASE

Background Bile acid reflux is an important component of duodenogastro -oesophageal reflux but there is no effective method of quantifying it . The contribution of bile acids to oesophageal pH is unknown. Methods Oesophageal aspirates were collected over 15 h using a new automated suction device and pH was monitored in ten asymptomatic Volunteers (gr oup 1) and 30 patients with reflux oesophagitis (group 2, minimal muco sal injury; group 3, erosive oesophagitis; group 4, stricture or Barre tt's oesophagus). Bile acid assay was performed by high-performance li quid chromatography. Results The concentration of bile acids was signi ficantly higher in group 3 (median (interquartile range) 124 (50-301) mu mol/l) and group 4 (181 (85-591) mu mol/l) compared with group I (0 mu mol/l) and group 2 (14 (0-100 mu mol/l). Patients in groups 3 and 4 also had significantly greater DeMeester acid scores, Combined bile acid and oesophageal acid reflux was observed in eight of ten patients with stricture or Barrett's oesophagus, There was no correlation betw een total bile acid concentration and oesophageal acid or alkaline exp osure. Conclusion This study supports the theory of toxic synergism be tween acid and bile acids in reflux oesophagitis. Bile acids may contr ibute to the pathogenesis of Barrett's metaplasia.