Significance of Ambulatory Intraesophageal Bilirubin Monitoring in Diagnosis of Gastroesophageal Reflux

Harushi Osugi, Masayuki Higashino, Taigou Tokuhara, Susumu Kaseno, Nobuyasu Takada, Yoshihiko Nishimura, Masasi Takemura, Takanobu Funai, Eiki Okuda and Hiroaki Kinoshita

Second Dept. of Surgery, Osaka City University, Medical School

To evaluate the usefulness of ambulatory intraesophageal bilirubin monitoring in the diagnosis of gastroesophageal reflux, 24 patients with reflux symptoms and 5 controls without symptoms were studied, and the results were compared with that of pH monitoring. The bilirubin monitoring was performed by spectrophotometry using Bilitec 2000 (Synectics Medical AB, Stockholm, Sweden). Bilirubin reflux or acid reflux was judged when absorbance was 0.15 or more, or when pH was less than 4 in the esophagus at 5 cm oral to the pressure inversion point, respectively. The duration of each reflux compared to the total observed period was obtained to determine percentage of time. Twenty-four hour monitoring was completed in all of 29 subjects. Percentage of time of bilirubin and acid reflux was less than 5% in all controls. In 3 patients with symptoms and without any evidence of morphological abnormalities in the upper gastrointestinal tract or biliary tree, percentage of time of acid reflux was less than 5%, but percentage of time of bilirubin reflux was more than 8% in 2 patients. Reflux esophagitis was found in the other 21 patients. Acid reflux was found only in 1 of 4 patients who had a history of subtotal gastrectomy, but abnormal bilirubin reflux was found in all 4 patients. In the other 17 patients, a significant difference was found in the amount of percentage of time of bilirubin reflux by the severity of reflux esophagitis, whereas this difference was not found in that of acid reflux. Intraesophageal bilirubin monitoring using Bilitec 2000 can be performed safely with pH monitoring and is useful in the diagnosis and evaluation of the severity of gastroesophageal reflux. Furthemore, bilirubin monitoring could be essential in patients with hypochlorhydria or minimal reflux.

Key words
gastroesophageal reflux, bilirubin monitoring, pH monitoring

Reprint requests
Harushi Osugi Second Department of Surgery, Osaka City University, Medical School 1-4-3 Asahimachi Abeno-ku, Osaka, 545-8585 JAPAN

Accepted
March 31, 1999

To read the PDF file you will need Abobe Reader installed on your computer.