The Correlation between Duodenogastroesophageal Reflux and Gastric Emptying in Patients with Typical Symptoms of Gastroesophageal Reflux

Paik, Seung Woon; Rhee, Jong Chul; Kim, Jae Jun; Koh, Kwang Cheol; Rhee, Poong Lyul; Jeon, Seong Gook

Abstract

BACKGROUND AND AIMS: Duodenogastroesophageal reflux (DGER) has been reported to occur in gastroesopahgeal retlux disease (GERD) and has been known to have a synergistic role in the development of esophageal mucosal injury. There is controversy on the role of delayed gastric emptying in the pathophysiology of GERD. The aim of this study is to evaluate the correlation between DGER and gastric emptying (total and proximal) in patients with typical symptoms of gastroesophageal reflux (GER).
METHODS
Simultaneous monitoring of ambulatory 24-hr esophageal pH and biIirubin (using Bilitec 2000) and esophagogastroduodenoscopy were done in 38 patients with typical symptoms of GER (19 male, mean age: 44.1 years). Gastric emptying scan was performed using 99mTc-DTPA labelled solid meal in the above patient group and 10 healthy controls (6 male, mean age: 32.5 years), and then total gastric emptying time (T1/2) and proximal gastric emptying time (PT1/2) were measured.
RESULTS
1) Abnormal acid reflux without abnormal bile reflux was diagnosed in 8 (21.1%) of 38 patients (Group I). Abnormal bile reflux was diagnosed in 10 (26.3%) of 38 patients (Group II). There was neither acid nor bile reflux in 20 (52.6%) of 38 patients (Group III). 2) Total gastric emptying time (T1/2) was not significantly different between controls and each groups. 3) Proximal gastric emptying time (PT1/2) was significantly delayed in Group II (94.2+/-37.6 min) when compared with controls (59.9.+/-24.2 min)(p<0.05).
CONCLUSIONS
Delayed proximal gastric emptying could be a contributing factor in the pathophysiology of duodenogastroesophageal reflux in gastroesophageal reflux disease.