Abstracts
1999 Digestive Disease Week

# 2099 SIMULTANEOUS ASSESSMENT OF ESOPHAGEAL AND GASTRIC BILIRUBIN EXPOSURE IN GERD
Martin Fein, Karl H Fuchs, Stefan M Freys, Johannes Heimbucher, Joern Maroske, Harald Tigges, Arnulf Thiede, Univ of Wuerzburg, Wuerzburg Germany

Reflux of duodenal juice potentiates the injurious effects of gastroesophageal reflux. To date, duodenal reflux was primarily assessed in the esophagus. Little is known about gastric exposure to duodenal juice in patients with reflux disease, although duodeno-gastric reflux is a prerequisite for duodeno-esophageal reflux. Simultaneous esophageal and gastric recordings of bilirubin exposure were evaluated in 87 patients with no previous surgery and GERD documented on pH monitoring (51 y (22-76); 59 m, 28 f). Bilirubin exposure was measured in total time % exceeding the absorbance treshold. Normal exposure was assessed in healthy volunteers. Low levels of gastric bilirubin exposure were physiologic, while esophageal bilirubin exposure was pathologic: 95th percentiles: esophagus: 11.8%, n=35; stomach: 25%, n=25. Esophageal bilirubin exposure was correlated with gastric exposure (r=0.51, p<0.0001), but not correlated with esophageal acid exposure (r=0.02). Bilirubin exposure in the esophagus was significantly higher in patients with increased gastric exposure compared to patients with physiologic gastric exposure (15.9±18.0 versus 37.0±27.8%, p<0.001, Wilcoxon). Esophageal injury (esophagitis or Barrett) was significantly related to gastric bilirubin exposure (table). In conclusion, gastric bilirubin exposure is an important factor for the progression of GERD. Esophageal reflux of duodenal juice is not just a side effect of acid reflux, but a consequence of increased amounts of duodeno-gastric reflux.

Increased exposure	No injury	Esophagitis	Barrett	p	Sum
N	22	43	22		87
Esophagus	10 (46%)	23 (54%)	16 (73%)	0.16	49 (56%)
Stomach	3 (14%)	20 (47%)	8 (36%)	0.03	31 (36%)

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