Abstracts
1997 Digestive Disease Week

Duodenogastroesophageal reflux in patients with short segment Barrett's esophagus.

MP Ritter, S Oberg, TR DeMeester, JH Peters, M Gadenstatter, PF Crookes, M Fein, CG Bremner. University of Southern California, Department of Surgery, Los Angeles, CA.

While the association of increased amounts of duodenogastroesophageal reflux (DGER) has been established for patients with long segments (>=3cm) of Barretts metaplasia, there is little information about the presence of DGER in patients with short segments (<3cm). This study evaluates the prevalence of increased DGER and the exposure time to DGER in these patients and relates it to esophageal injury.

Thirty-five normal volunteers and 260 consecutive patients with foregut symptoms underwent upper endoscopy, stationary motility and spectrophotometric bilirubin (Bilitec) monitoring. Based on the findings on upper endoscopy the patients were divided into four groups: 1) patients with no mucosal injury (n= 131), 2) patients with erosive esophagitis (n= 70), 3) patients with short segments (<3cm) of intestinal metaplasia (n=27) and 4) patients with long segments (>=3cm) of intestinal metaplasia in the esophagus (n=32). The distance between the proximal extent of the gastric rugal folds and the highest biopsy showing specialized intestinal metaplasia was defined as the length of Barretts esophagus. The prevalence of increased esophageal bilirubin exposure and the exposure time (% time absorbance > 0.2) were compared between the four groups of patients and normal volunteers. Increased esophageal bilirubin exposure was diagnosed when the total % time above an absorbance threshold of 0.2 exceeded the 95^{th} percentile measured in healthy volunteers (1.7%).

The prevalence of increased esophageal bilirubin exposure tended to increase with the degree of esophageal mucosal injury (table). The exposure time to DGER was similar in patients with esophagitis and patients with short segments of intestinal metaplasia in the esophagus and tended to be higher in patients with long segments. The prevalence and the exposure time to bilirubin in all three groups of patients with mucosal injury were significantly higher than in patients with no mucosal injury.

                     N    Increased bilirubin   % time absorbance > 0.2
                             exposure [%]              [mean ± SD]
Normal volunteers    35         5.7                     0.4 ± 1.5
No mucosal injury    131        35                      5.9 ± 14.0
Esophagitis          70         64**                   16.3 ± 19.7*
Short segment IM     27         70**                   13.5 ± 16.8
Long segment IM      32         78**                   18.9. ± 20.4*
* p<0.05 (ANOVA) vs normal volunteers and no injury
** p<0.05 (Fishers exact; Bonferroni adjusted) vs no injury

Patients with short segments of intestinal metaplasia in the esophagus have increased exposure to DGER similar to other patients with esophageal mucosal injury.