Problems of 24-Hour Ambulatory Bile Reflux Monitoring (Bilitec(R)) in Diagnosing Duodenogastric Reflux

Sohn, Chong Il; Jun, Sung Kook; Lee, Wha Young; Rhee, Poong Lyul; Kim, Jae Jun; Ko, Kwang Cheol; Paik, Seung Woon; Rhee, Jong Chul; Kim, Hong Sik; Yoon, Gil Won

Abstract

BACKGROUND AND AIMS: Duodenogastric reflux is thought to be a potential cause of functional dyspepsia but this point is still in debate. Many types of tests were used to diagnose duodenogastric reflux but none was accepted as the gold standard. In recent years, a 24-hour ambulatory bile reflux monitoring (Bilitec(R)) was introduced. This study was done to analyze the amount and the frequency of duodenogastric reflux and to investigate the efficacy and prnblems of Bilitec(R) in functional dyspeptic patients and normal controls.
METHODS
We first measured optical absorbance of 20 common Korean foods. We exarnined 10 functional dyspeptic patients with endoscopic evidence of bile regurgitation, 10 gastritis or peptic ulcer disease patients ancl 10 asymptomatic normal controls with Bilitec(R). Duodenogastric reflux was considered as positiv= when bile absorbance exceeded 0.14 during Bilitec(R) examination. We also investigated technical difficulties and patients tolerance during the Bilitec(R) examination.
RESULTS
Among the 20 Korean foods, kimchi, soybean paste, cabbage, apple, and egg gave false positives on the Bilitec(R) examination. Technically, the probe was located optimally on the antrum in only 23 out of 30 subjects, but the probe was located on the body in two, the fundus in three and the probe could not be inserted due tv poor cooperation in three. At the end of the examination, 54% of subjects complained of more discomfort when compared to endoscopy. There was no significant difference in duodenogastric reflux between functional dyspeptic patients and asymptomatic normal controls. There was one case which failed the Bilitec(R) exam due to probe malfunction.
CONCLUSIONS
Bilitec(R) examination is thought to be the best method in the diagnosis of duodenogastric reflux yet. However, some protilems such as false positivity influenced by food material, technical difficulty in locating the probe, probe malfunction and patients discomfort exist. In this study, the role of duodenogastric reflux as a cause of functional dyspepsia is not certain.