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Prevalence of pathological duodenogastric reflux and the relationship between duodenogastric and duodenogastrooesophageal reflux in chronic gastrooesophageal reflux disease

Brillantino, Antonio; Monaco, Luigi; Schettino, Michele; Torelli, Francesco; Izzo, Giuseppe; Cosenza, Angelo; Marano, Luigi; Di Martino, Natale

European Journal of Gastroenterology & Hepatology: December 2008 - Volume 20 - Issue 12 - p 1136-1143
doi: 10.1097/MEG.0b013e32830aba6d
Original Articles: Gastro-Oesophageal Disorders

The role of duodenogastric reflux in gastrooesophageal reflux disease is still controversial.

Aims (i) To determine the prevalence of pathological duodenogastric reflux (DGR) in gastrooesophageal reflux disease patients and (ii) to define the relationship between DGR and duodenogastrooesophageal reflux.

Methods We evaluated 92 patients referred for investigation of recurrent reflux symptoms after proton pump inhibitors (PPI) therapy. All the patients filled out symptom questionnaires and underwent endoscopy, oesophageal manometry and combined oesophagogastric pH and bilirubin monitoring.

Results Endoscopy divided the 92 patients into four groups (group I: 25 nonoesophagitis patients, group II: 26 patients with grade A–B oesophagitis, group III: 21 patients with grade C–D oesophagitis and group IV: 20 patients with Barrett's oesophagus. Twenty-four of the 92 patients (26%) showed pathological DGR. Abnormal oesophageal bilirubin exposure was observed in 62 of the 92 patients (67.4%). Of the 62 patients with abnormal oesophageal bilimetry, 15 (24.2%) patients simultaneously showed pathological DGR. The gastric bilirubin exposure in patients with abnormal oesophageal, Bilitec tests did not differ from that in patients with normal oesophageal bilimetry (P>0.05). A weak correlation between oesophageal and gastric bilirubin exposure, both expressed as a percentage of time, was found (r=0.28; P<0.01).

Conclusion Pathological DGR is present in a little more than a quarter of patients with recurrent reflux and dyspeptic symptoms after PPI therapy. Excessive DGR is not a prerequisite for pathological oesophageal exposure to duodenal contents. Gastric bilirubin monitoring may be useful to choose the best surgical treatment for patients with reflux and dyspeptic symptoms refractory to PPI.

VIII Department of General and Gastrointestinal Surgery, School of Medicine, Second University of Naples, Naples, Italy

Correspondence to Antonio Brillantino, MD, School of Medicine-I Policlinico, Second University of Naples, Piazza Miraglia 2, Naples 8013, Italy


Received 19 February 2008 Accepted 29 May 2008

© 2008 Lippincott Williams & Wilkins, Inc.