Bile reflux in patients with nerd is associated with more severe heartburn and lower values of mean nocturnal baseline impedance and chemical clearance

Nicola de Bortoli, C. Prakash Gyawali, Marzio Frazzoni, Salvatore Tolone, Leonardo Frazzoni, Eleonora Vichi, Pierfrancesco Visaggi, Massimo Bellini, Elisa Marabotto, Roberto Penagini, Vincenzo Savarino, Santino Marchi, Edoardo V. Savarino

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Mean nocturnal baseline impedance (MNBI) and postreflux swallow-induced peristaltic wave (PSPW) index are novel impedance-based markers of reflux, but the effect of bile reflux on these metrics is unknown. The aim of this study was to evaluate bile reflux, MNBI, and PSPW index in patients with endoscopy-negative GERD partially responsive to PPI therapy. Methods: All patients underwent off-PPI endoscopy, esophageal manometry, multichannel intraluminal impedance pH (MII-pH), and bile reflux monitoring. Abnormal esophageal acid exposure time (AET) was required for inclusion. Symptom intensity (using 10-cm visual analog scales), and conventional and novel MII-pH metrics were compared between patients with and without abnormal bile reflux. Key Results: We evaluated 42 NERD patients (29 males, mean age: 53.4 ± 13. years), mean AET 6.1 ± 2%, of which 21 had abnormal bile reflux (Group A, 10.2 ± 4.9%), and 21 had normal bile reflux (Group B, 0.4 ± 0.1%, P <.05 compared with Group A). Heartburn reporting on PPI was higher in Group A (7.2 ± 2.1 vs 5.8 ± 0.9; P =.002), but AET, number of reflux events (acidic and weakly acidic), did not differ between the two groups. However, both PSPW index and MNBI were lower in Group A (P <.001). A strong inverse linear correlation was found between bile reflux and both MNBI (Pearson's test; R = −0.714; P <.001) and PSPW index (R = −0.722; P <.001). Conclusions and Inferences: Compared to acid reflux alone, the presence of bile in an acidic esophageal environment is associated with more severe heartburn, lesser relief from PPI therapy, higher impairment of esophageal mucosal integrity and less effective chemical clearance.

Original languageEnglish
Article numbere13919
JournalNeurogastroenterology and Motility
Volume32
Issue number12
DOIs
Publication statusPublished - 2020

Keywords

  • biliary reflux
  • GERD
  • mean nocturnal baseline impedance
  • PPI
  • PSPW index

ASJC Scopus subject areas

  • Physiology
  • Endocrine and Autonomic Systems
  • Gastroenterology

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