Duodenogastric reflux has long been associated with various diseases of the
foregut. Even though bile is often used as a marker, duodenogastric reflux
consists of other components such as pancreatic juice and duodenal secreti
ons. The aim of this study was to investigate the occurrence of duodenogast
ric reflux, its components, and the variability of its composition in norma
l subjects. Twenty healthy volunteers (7 men and 13 women) whose median age
was 24 years underwent combined 24-hour bilirubin and gastric pH monitorin
g and intraluminal gastric aspiration. All probes were placed at 5 cm below
the lower border of the lower esophageal sphincter. Aspiration was perform
ed hourly and at any time when bilirubin and/or pH monitoring showed signs
of duodenogastric reflux. Elastase and amylase were measured in the aspirat
e. All volunteers had episodes of physiologic duodenogastric reflux. A tota
l of 70 episodes of duodenogastric reflux were registered with a median of
three episodes (range 1 to 8) per subject. Most bile reflux occurred separa
tely from pancreatic enzyme reflux. Pancreatic enzyme aspirate was signific
antly more often associated with a rise in pH in comparison to bile reflux
(P <0.01). Duodenogastric reflux is a physiologic event with varying compos
ition. Both bile and pancreatic enzyme reflux frequently occur separately.
These findings could explain the disagreement regarding assessment and inte
rpretation of duodenogastric reflux in the past. Thus monitoring of duodeno
gastric reflux requires more than the detection of just one component.