Bile reflux into the esophagus - Bilitec 2000 measurements in normal subjects and in patients after Nissen fundoplication

Background: Bilitec 2000 is a new spectrophotometric system that can detect bilirubin within the esophagus. The aim of this study was to test this new system in vitro and in vivo with special attention to patients operated on laparoscopically for gastroesophageal reflux with Nissen fundoplication. M ethods: In vitro studies of gallbladder bile dilution curves at different p Hs were performed with a combined pH and Bilitec probe and by investigation of the drift of the Bilitec system. In vivo studies were performed in 34 n ormal individuals and 12 patients operated on with a laparoscopic Nissen fu ndoplication. Intra/intervariations were evaluated in normal individuals. R esults: The Bilitec system was able to detect changes in absorbance value w ithin the range 0.14-0.6. Absorbance values were about 30% lower in an acid environment. The percentage of the total time with bile reflux was a media n (range) of 3.9 (0-49.6) in normal individuals, with an intravariation wit hin the intervariation, and 8.7 (0-36.6) in patients after a Nissen fundopl ication. These values did not differ significantly. Eighty-two per cent of the normal subjects had some degree of bile reflux, if an absorbance value greater than or equal to 0.14 was accepted as the threshold value for the p resence of bile reflux. Conclusions: Bile reflux in normal individuals is f requent and not different from that in patients after a Nissen fundoplicati on. Surprisingly, the latter had bile reflux but no or minimal acid reflux. Factors other than bilirubin may interfere with the measurements.