Fiberoptic technique for 24-hour bile reflux monitoring |
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Authors: | Dr. Martin Fein MD PhD Karl-Hermann Fuchs MD Thomas Bohrer Stephan M. Freys MD Arnulf Thiede MD |
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Affiliation: | (1) Department of Surgery, University of Würzburg, Josef-Schneider-Str. 2, 97080 Würzburg, Germany;(2) Chirurgische Universitätsklinik, Josef-Schneider-Str. 2, 97080 Würzburg, Germany |
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Abstract: | Physiologic bile reflux was assessed in 27in vivo test with healthy volunteers to define a standardized protocol and normal values for 24-hour enterogastric bile reflux monitoring (protocol with supine, upright, and meal phases and a free diet avoiding alcohol, smoking, and coffee, evaluation with different thresholds of absorbance units: 0.14, 0.25).In vitro tests with bile-sodium solutions demonstrated a linear dependence of absorbance for bilirubin up to 600 mol/liter (range of the fiberoptic device: 0.0–1.0). Fluids and food might interfere with absorbances below 0.25 (exception: coffee).In vivo bile often remains in the stomach for more than 1 hr; these events were defined as reflux episodes. The upper limits for physiologic bile reflux are a percentage of total time of bile reflux of 28.2% and an average absorbance during a reflux episode of 0.62 (95th percentile with threshold 0.25). Comparing bile with pH monitoring (absorbance>0.25 and/or pH>4), an increase of bilirubin was found most frequently with constant pH (45%) or an increase of pH with constant bilirubin (36%). The hypothesis was drawn that bile and duodenal or pancreatic secretions may separately contribute to duodenogastric reflux. |
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Keywords: | fiberoptics bile reflux monitoring |
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