Influence of pantoprazole on oesophageal motility, and bile and acid reflux in patients with oesophagitis

Background: Reflux of duodeno-gastric juice into the oesophagus appears to be involved in the pathogenesis of both reflux oesophagitis and oesophageal adenocarcinoma. Although proton pump inhibitors have been shown to decreas e acid reflux and heal oesophagitis, their effect on biliary reflux and mot ility is less clear. Aim: To investigate whether pantoprazole also reduces bile reflux and wheth er this is paralleled by a change in oesophageal motility. Methods: Combined 24-h measurements of intraoesophageal bilirubin concentra tion, pH and pressure were performed in 18 symptomatic patients with endosc opically proven reflux oesophagitis before and on day 28 of treatment with pantoprazole, 40 mg/day, under standardized conditions. A reflux symptom sc ore was determined initially and every 2 weeks thereafter. After 56 days on medication, a control endoscopy was performed. Results: The symptom score and the acid and bile reflux improved significan tly, whereas the motility parameters did not change during the study period . Helicobacter pylori-positive patients had a significantly higher bile ref lux time (32.1 +/- 4.3%) than H. pylori-negative patients (16.3 +/- 3.1%) ( P = 0.009). The endoscopic healing rate was 89%. The cough symptoms disappe ared in three of four patients. Conclusions: The proton pump inhibitor pantoprazole decreases both acid and bile reflux. The decrease of bile reflux cannot be explained by increased oesophageal clearance as oesophageal motility did not improve with therapy. Interestingly, H. pylori infection of the stomach was associated with high er levels of oesophageal bile reflux.