Gastric symptoms and duodenogastric reflux in patients referred for gastroesophageal reflux symptoms and endoscopic esophagitis

Background. The role of excessive duodenogastric reflux (DRG) in the genesi s of gastric symptoms in patients primarily referred for both gastroesophag eal reflux (GER) symptoms and esophagitis is poorly understood. Methods. The study is based on the clinical, endoscopic, histologic, and 24 -hour gastric data from the Bilitec optoelectronic device (Prodotec, Floren ce, Italy, licensed by Synectics Medical, Stockholm, Sweden) from 49 patien ts having both typical GER symptoms and gastric symptoms suggestive of exce ssive DGR (ie, epigastric pain, nausea, or bilious vomiting) in the absence of previous esophageal or gastric surgery (group I). Helicobacter pylori o rganisms were searched for on antral biopsy specimens with use of the Giems a method. The percentages of total, upright, and supine time during which a bsorbance exceeded various thresholds through all the working range of the Bilitec device were calculated. Bilitec data from group 1 were compared wit h those from 16 patients with endoscopic esophagitis and GER symptoms only (group 2) and 25 healthy subjects (group 3). Results. The prevalence of an abnormal Bilitec test result in group 1 incre ased from 27% (13/49) at the 0.25 absorbance threshold to 36% (18/49) at th resholds ranging from 0.40 to 0.60 and to 41% (20/49) when multiple thresho lds ranging from 0.25 to 0.30 threshold, whereas the other 15 patients had a normal test result. H pylori antral infection was present in 14 group 1 p atients. None of these had an abnormal Bilitec test result, whereas the tes t was positive in 40% of the H pylori-negative patients without endoscopic gastritis and in 70% of H pylori-negative patients with endoscopic gastriti s (P = .001). Conclusions. Twenty-four-hour intragastric bile monitoring provides the cli nician with unequivocal evidence of excessive DGR in 41% of patients with a n intact stomach having endoscopic esophagitis, GER symptoms, and gastric s ymptoms suggestive of DGR. The most dependable data are obtained when absor bance thresholds higher than 0.40 are considered. H pylori antral infection and excessive DGR at 24-hour intragastric bile monitoring are mutually exc lusive.