Synergism of acid and duodenogastroesophageal reflux in complicated Barrett's esophagus.

BACKGROUND: The role of acid and duodenogastroesophageal reflux (DGER) in the development of complications in Barrett's esophagus is controversial. We characterized the esophageal reflux constituents in patients with and without complications of Barrett's esophagus.

METHODS: Using a new fiber-optic system we studied 12 normal subjects (six male; mean age, 46 years) and 20 patients with Barrett's esophagus (17 male; mean age, 58 years), nine with uncomplicated (seven male; mean age, 55 years) and 11 with complicated Barrett's esophagus (seven with stricture, two with ulcer, and two with dysplasia; 10 male; mean age, 61 years). Fasting gastric bile acid concentrations were measured. Twenty-four-hour ambulatory acid and bilirubin measurements were obtained with the fiber-optic system by using a glass electrode and fiber-optic sensor. The data were then analyzed for percent total time pH < 4 and > 7 and bilirubin absorbance > 0.14%.

RESULTS: Percent times pH < 4, bilirubin absorbance > 0.14%, and fasting gastric bile acid concentrations were significantly greater in patients with complicated Barrett's esophagus compared with patients with uncomplicated Barrett's esophagus with both being higher than the controls. Acid reflux paralleled bile reflux in the two Barrett's esophagus groups (r = 0.44, p < 0.05), but percent time pH > 7 did not differentiate between the two groups.

CONCLUSIONS: (1) Patients with complicated Barrett's esophagus reflux significantly greater amounts of both acid and duodenal contents than patients with uncomplicated Barrett's esophagus. (2) Complications in Barrett's esophagus may be due to synergism between acid and bile rather than either constituent alone.