The extent of duodenogastric reflux in gastro-oesophageal reflux disease

Background It is known that duodenogastro-oesophageal reflux (DGOR) increas es with worsening gastrooesophageal reflux disease (GORD). It is unclear wh ether this is accompanied by increasing duodenogastric reflux (DGR), Objective To investigate the extent of DGR in a control group and 66 patien ts with GORD, using the technique of ambulatory gastric bilirubin monitorin g. Methods Sixty-six patients with reflux symptoms (30 grade 0 or 1 oesophagit is (group 1), 16 grade 2 or 3 oesophagitis (group 2), 20 Barrett's oesophag us (group 3)) and 17 healthy controls were studied. All underwent oesophage al manometry followed by 24-h ambulatory oesophageal and gastric pH monitor ing and gastric bilirubin monitoring. Results Median per cent total oesophageal acid exposure (pH < 4) was signif icantly less in the control group (0.6%) than in group 1 (2.8%, P < 0.05) a nd groups 2 and 3 (7.5% and 7.8% respectively, P < 0.001), There was no sig nificant difference between any group in median per cent total time gastric pH was greater than 4. There was no significant difference in median per c ent total gastric bilirubin exposure (absorbance >0.14) between any group. However, in each group gastric bilirubin exposure was greater in the supine position than the upright position, being significantly greater in the con trol group (P < 0.05) and group 1 (P < 0.001), Conclusions Gastric bilirubin exposure is similar across the spectrum of GO RD severity. It is greater in the supine than in the upright position, Eur J Gastroenterol Hepafol 13:5-10 (C) 2001 Lippincott Williams & Wilkins.