Abstracts
1998 Digestive Disease Week

#2331

VARIABILITY IN THE COMPOSITION OF PHYSIOLOGIC DUODENO-GASTRIC REFLUX. K.-H. Fuchs, J. Maroske, M. Fein, H. Tigges, M.P. Ritter, J. Heimbucher, A. Thiede. Department of Surgery, University of Würzburg, Germany.

Background: Duodenogastric reflux (DGR) has been associated with foregut disease. Even though bile is often used as a marker, DGR consists of other components such as pancreatic juice and duodenal secretions.

Aim: To investigate the occurrence of DGR, its components, and the variability of its composition in normal subjects.

Methods: 20 healthy volunteers (10 m and 10 f) with a median age of 24 years underwent history and physical examination, upper GI endoscopy, esophageal manometry, and 24h esophageal pH monitoring to exclude any foregut disease. These individuals underwent combined 24h bilirubin- and gastric pH-monitoring and intraluminal gastric aspiration. All probes were placed at 5 cm below the lower border of the lower esophageal sphincter. Food intake was restricted to defined meal periods. Aspiration was performed hourly and at any time when bilirubin and/or pH monitoring showed signs of DGR. Elastase and amylase were measured in the aspirate. Episodes of DGR were classified in bile reflux (Bilitec absorbance > 0.25), pH rise above 3 (pH), and episodes with pancreatic enzymes in the aspirate (PEA);(elastase > 0.3 ng/dl, amylase > 10 U/l). Meal periods and the first 2 postprandial hours were excluded from the analysis.

Results: All volunteers showed episodes of physiologic DGR. A total of 70 DGR episodes were registered with a median of 3 episodes (range 1-7) per subject. The table lists the number of DGR episodes, all possible combinations, and the frequency of their occurrence in the study population. The majority of bile reflux occured separately from pancreatic enzyme reflux and a pH rise was significantly more often associated with PEA than with bile reflux (p<0.01).

Conclusion: DGR is a physiologic event with varying composition. Both bile and pancreatic reflux frequently occur separately. These findings could explain the controversies of DGR assessment and interpretation in the past. Thus, DGR monitoring requires more than the detection of one component.

Copyright 1996 - 1998, SSAT, Inc. Revised 29 June 1998.