Refluks żółciowy – Diagnostyka i diagnoza

Refluks żółciowy
Diagnostyka i diagnoza

Refluks żółciowy to patologiczny stan, w którym żółć cofa się do żołądka i przełyku, często współistniejąc z refluksem kwasu żołądkowego (GERD). Diagnostyka jest wyzwaniem ze względu na podobieństwo objawów do GERD oraz brak patognomonicznych cech endoskopowych i histologicznych. Kluczowe metody diagnostyczne obejmują endoskopię górnego odcinka przewodu pokarmowego, ambulatoryjne badania kwasowości, impedancję przełykową oraz specjalistyczne techniki, takie jak system Bilitec 2000, scyntygrafia wątrobowo-żółciowa (HIDA) i 24-godzinne monitorowanie pH-impedancji. Szczególną uwagę zwraca się na wykluczenie innych przyczyn objawów, takich jak dyspepsja czynnościowa, infekcja Helicobacter pylori czy gastropareza, oraz identyfikację czynników ryzyka, w tym płci żeńskiej, otyłości, cukrzycy i wcześniejszych operacji jamy brzusznej.

Diagnostyka refluksu żółciowego

Refluks żółciowy (bile reflux) to stan, w którym żółć, płyn trawienny produkowany w wątrobie, cofa się (refluksuje) do żołądka, a w niektórych przypadkach również do przełyku. W przeciwieństwie do refluksu kwasu żołądkowego, refluks żółciowy nie może być całkowicie kontrolowany poprzez zmiany diety czy stylu życia, co czyni jego diagnozę i leczenie bardziej skomplikowanymi.¹²

Diagnostyka refluksu żółciowego jest szczególnie trudna, ponieważ objawy często przypominają te występujące w refluksie kwasu żołądkowego (GERD). Rozróżnienie między tymi dwoma rodzajami refluksu wymaga przeprowadzenia specjalistycznych badań, a często oba stany współistnieją u jednego pacjenta.³⁴

Podstawowe metody diagnostyczne

Pierwszym krokiem w diagnostyce refluksu żółciowego jest zebranie dokładnego wywiadu medycznego i ocena objawów pacjenta. Choć same objawy mogą sugerować problem refluksowy, to odróżnienie refluksu żółciowego od kwasowego wymaga dalszej diagnostyki.⁵⁶

Do najważniejszych metod diagnostycznych należą:

Endoskopia górnego odcinka przewodu pokarmowego – cienki, elastyczny przewód z kamerą (endoskop) jest wprowadzany przez gardło. Endoskop może uwidocznić żółć, wrzody trawienne lub stan zapalny w żołądku i przełyku. Lekarz może również pobrać próbki tkanki w celu zbadania pod kątem przełyku Barretta lub raka przełyku.⁷⁸
Ambulatoryjne badania kwasowości – badania te wykorzystują sondę mierzącą kwasowość, aby określić kiedy i jak długo kwas refluksuje do przełyku. Ambulatoryjne testy kwasowe mogą pomóc lekarzowi wykluczyć refluks kwasowy, ale nie refluks żółciowy.⁹¹⁰
Impedancja przełykowa – badanie to mierzy, czy gaz lub płyny refluksują do przełyku. Jest przydatne u osób, które zwracają substancje niekwasowe (takie jak żółć), których nie można wykryć sondą kwasową.¹¹¹²

Zaawansowane metody diagnostyczne

W przypadku trudności diagnostycznych lub potrzeby dokładniejszej oceny refluksu żółciowego, stosowane są bardziej specjalistyczne metody badawcze:

System monitorowania Bilitec 2000 – metoda opracowana w celu identyfikacji zmian koloru refluksatu w przełyku. Ponieważ żółć ma specyficzny zakres kolorów, to fotokolorymetryczne urządzenie umożliwia lekarzowi określenie, czy w refluksacie znajduje się żółć, a jeśli tak, to ile i jak długo pozostawała w przełyku.¹³¹⁴
Scyntygrafia wątrobowo-żółciowa (HIDA) – najmniej inwazyjna metoda badania refluksu żółciowego, charakteryzująca się dobrą tolerancją przez pacjentów, czułością i powtarzalnością. Jest to badanie wykorzystujące znaczniki radioaktywne do oceny przepływu żółci.¹⁵¹⁶
Badanie biochemiczne aspiratu przełykowego – jeśli treść przełyku jest aspirowana podczas refluksu, analiza biochemiczna może zidentyfikować obecność żółci w płynie, który dostał się do przełyku. Żółć nie powinna znajdować się w przełyku, więc jej obecność wskazuje na refluks żółciowy. Ta metoda diagnostyczna nie jest jednak zbyt praktyczna.¹⁷
24-godzinne monitorowanie pH-impedancji – główna metoda diagnozowania patologicznego refluksu dwunastniczo-żołądkowego.¹⁸

Diagnostyka różnicowa

Diagnostyka refluksu żółciowego wymaga wykluczenia innych przyczyn podobnych objawów. Szczególne znaczenie ma odróżnienie refluksu żółciowego od kwasowego, co może być trudne ze względu na podobne objawy.¹⁹²⁰

W diagnostyce różnicowej refluksu żółciowego należy uwzględnić:

Refluks kwasu żołądkowego (GERD)
Dyspepsję czynnościową
Infekcję Helicobacter pylori
Chorobę wrzodową
Gastroparezę

Identyfikacja czynników ryzyka refluksu żółciowego ma istotne znaczenie diagnostyczne. Do najważniejszych należą: płeć żeńska, młody lub podeszły wiek, budowa asteniczna, nawyki żywieniowe z nadmiernym spożyciem słodyczy, tłuszczów nasyconych, otyłość, współistniejąca patologia układu wątrobowo-żółciowego, cukrzyca, przebyte operacje żołądka i/lub pęcherzyka żółciowego.²¹

Markery diagnostyczne

W diagnostyce refluksu żółciowego nie istnieją patognomoniczne makro- lub mikroskopowe oznaki. Diagnoza stawiana jest na podstawie kompleksowej oceny stanu obiektywnego i danych z wywiadu, przede wszystkim w odniesieniu do współistniejących chorób dróg żółciowych oraz wcześniejszych interwencji chirurgicznych na narządach jamy brzusznej, które mogą przyczyniać się do powstania refluksu dwunastniczo-żołądkowego.²²

Badania endoskopowe mogą ujawnić charakterystyczne przekrwienie i zaczerwienienie błony śluzowej żołądka (często opisywane jako „wołowy czerwony żołądek” lub „czerwono-zielony żołądek”) oraz, okazjonalnie, inkrustację błony śluzowej kryształami żółci. Pomimo dramatycznego wyglądu, korelacja między wyglądem endoskopowym a objawami pacjentów jest słaba, dlatego ocena histologiczna jest uzasadniona w celu potwierdzenia diagnozy i wykluczenia współistniejącej infekcji Helicobacter pylori.²³

Podczas diagnostyki refluksu żółciowego istotne jest również wykluczenie potencjalnie groźnych powikłań, takich jak:

Przełyk Barretta
Zmiany przedrakowe przełyku i żołądka
Zapalenie przełyku
Owrzodzenia

Znaczenie kliniczne refluksu żółciowego

Refluks żółciowy ma istotne znaczenie kliniczne ze względu na swoją patogenność i związek z poważnymi powikłaniami. Wykazano, że pacjenci z większym refluksem żółciowym mają poważniejsze uszkodzenia błony śluzowej przełyku, istnieje więc wyraźna korelacja między ilością refluksu żółciowego a ciężkością zapalenia dystalnego odcinka przełyku.²⁴²⁵

Faktycznie, pacjenci z najcięższym stopniem zapalenia żołądkowo-przełykowego, przełykiem Barretta, to ci z największą ilością refluksu żółciowego. Znaczenie refluksu żółciowego ma więc związek przede wszystkim z ciężkością uszkodzenia błony śluzowej przełyku, rozwojem błony śluzowej Barretta i potencjalnie ryzykiem raka.²⁶²⁷

Wiadomo, że im więcej refluksu żółciowego u pacjenta, tym wyższe ryzyko rozwoju przełyku Barretta; zarówno badania in vivo, jak i in vitro wykazały związek między żółcią kontaktującą się z błoną śluzową przełyku a zmianami w błonie śluzowej zgodnymi z przełykiem Barretta.²⁸²⁹

Trudności w rozróżnieniu refluksu żółciowego od kwasowego

Rozróżnienie między refluksem żółciowym a kwasowym jest często wyzwaniem diagnostycznym. Oba stany mogą powodować podobne objawy, takie jak zgaga, nudności, wymioty i ból w nadbrzuszu.³⁰³¹

Istnieją jednak pewne wskazówki kliniczne, które mogą pomóc w rozróżnieniu:

Jeśli objawy obejmują wymioty, warto sprawdzić ich kolor. Żółć ma charakterystyczny żółty odcień.³²
Jeśli pacjent ma również objawy refluksu żółciowego w żołądku, takie jak ból brzucha i niestrawność, może to być ważna wskazówka.³³
Brak odpowiedzi na leczenie inhibitorami pompy protonowej może sugerować refluks żółciowy zamiast kwasowego.³⁴

Implikacje diagnostyczne dla leczenia

Prawidłowa diagnoza refluksu żółciowego ma kluczowe znaczenie dla skutecznego leczenia. Podczas gdy modyfikacje stylu życia i leki mogą być bardzo skuteczne w przypadku refluksu kwasu do przełyku, refluks żółciowy jest trudniejszy w leczeniu.³⁵³⁶

Istnieje niewiele dowodów oceniających skuteczność leczenia refluksu żółciowego, częściowo ze względu na trudności w ustaleniu refluksu żółciowego jako przyczyny objawów. Lekarze mogą zalecić operację, jeśli leki nie łagodzą poważnych objawów lub występują zmiany przedrakowe w żołądku lub przełyku.³⁷³⁸

Niektóre rodzaje operacji mogą być bardziej skuteczne niż inne, dlatego warto dokładnie omówić wady i zalety z lekarzem. Operacja jest leczeniem ostatniej szansy, stosowanym, gdy nic innego nie zmniejsza ciężkich objawów refluksu żółciowego lub gdy w przełyku rozwijają się zmiany przedrakowe.³⁹⁴⁰

Nowoczesne kierunki badań w diagnostyce refluksu żółciowego

Istnieją trzy główne kierunki badań w obszarze refluksu żółciowego:⁴¹⁴²

Wpływ kwasów żółciowych i soli żółciowych na błonę śluzową przełyku oraz rozwój przełyku Barretta i raka.
Rola refluksu żółciowego w pozaprzełykowych zespołach związanych z refluksem (np. rozwój zaburzeń oddechowych związanych z refluksem). Istnieją pewne dowody, że obecność żółci w aspiracji refluksatu do dróg oddechowych może być bardzo ważna w rozwoju zaburzeń oddechowych.
Rola żółci w patogenezie nieerozyjnej choroby refluksowej i objawów. Wiadomo, że pacjenci, którzy mają uporczywe objawy, takie jak zgaga lub regurgitacja, mogą mieć refluksat zawierający kwas żółciowy mimo przyjmowania inhibitorów pompy protonowej.

Najnowsze badania sugerują, że zmodyfikowana scyntygrafia wątrobowo-żółciowa (HIDA) może być obiecującą metodą diagnozowania refluksu żółciowego u pacjentów po operacji omijania żołądka z jednym zespoleniem (OAGB). W badaniu wykazano, że dostosowany protokół skanu HIDA wykrył refluks żółciowy u ponad połowy pacjentów po OAGB włączonych do badania, z wysoką czułością diagnostyczną.⁴³

Ograniczenia obecnych metod diagnostycznych

Pomimo postępów w diagnostyce refluksu żółciowego, obecne metody mają pewne ograniczenia:

Brak złotego standardu diagnostycznego dla refluksu żółciowego.⁴⁴⁴⁵
Trudności w odróżnieniu refluksu fizjologicznego od patologicznego.⁴⁶
Brak korelacji między nasileniem objawów a ilością żółci w refluksie.⁴⁷
Impedancja-pH, choć skuteczna w identyfikacji niekyasowego refluksu, nie jest uważana za odpowiednie narzędzie do diagnozowania epizodów refluksu żółciowego w przełyku ze względu na niemożność odróżnienia żółci od innych niekwasowych składników refluksatu, takich jak pokarm.⁴⁸

Rekomendacje dla praktyki klinicznej

Na podstawie dostępnych danych, można sformułować następujące rekomendacje dla diagnostyki refluksu żółciowego:

Diagnostyka refluksu żółciowego powinna opierać się na podejściu multidyscyplinarnym, łączącym dogłębną analizę dolegliwości pacjenta, wywiad chorobowy oraz wyniki metod badawczych endoskopowych i histologicznych.⁴⁹
Scyntygrafia wątrobowo-żółciowa jest obecnie najmniej inwazyjnym badaniem, z dobrą tolerancją przez pacjenta, czułością i powtarzalnością, które należy uznać za pierwszorzędowe w diagnostyce refluksu żółciowego.⁵⁰
U pacjentów z chorobą refluksową oporną na standardowe leczenie należy rozważyć refluks żółciowy jako potencjalną przyczynę.⁵¹
Procedury przeciwrefluksowe, szczególnie fundoplikacja metodą Nissena, wydają się być skuteczne w kontrolowaniu refluksu żółciowego.⁵²

W przypadku podejrzenia refluksu żółciowego, zwłaszcza u pacjentów z objawami refluksu nieodpowiadającymi na leczenie inhibitorami pompy protonowej, zaleca się konsultację z gastroenterologiem w celu przeprowadzenia odpowiedniej diagnostyki i ustalenia optymalnego planu leczenia.⁵³⁵⁴

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Materiały źródłowe

#1 Bile reflux – Symptoms & causes – Mayo Clinic
https://www.mayoclinic.org/diseases-conditions/bile-reflux/symptoms-causes/syc-20370115
Bile reflux occurs when bile a digestive liquid produced in your liver backs up (refluxes) into your stomach and, in some cases, into the tube that connects your mouth and stomach (esophagus). […] Unlike gastric acid reflux, bile reflux can’t be completely controlled by changes in diet or lifestyle. Treatment involves medications or, in severe cases, surgery. […] Make an appointment with your doctor if you frequently experience symptoms of reflux, or if you’re losing weight without trying. […] If you’ve been diagnosed with gastroesophageal reflux disease (GERD) but aren’t getting enough relief from your medications, call your doctor. You may need additional treatment for bile reflux. […] Bile reflux may be caused by: […] Surgery complications. Stomach surgery, including total or partial removal of the stomach and gastric bypass surgery for weight loss, is responsible for most bile reflux.
#2 Management of Bile Reflux
https://pmc.ncbi.nlm.nih.gov/articles/PMC3745208/
Bile reflux is very infrequent in healthy individuals. […] This condition is more severe in patients with gastroesophageal reflux disease, particularly those with severe esophagitis and/or Barrett esophagus. […] The first, and most obvious, method of diagnosis is to detect the presence of bile and then measure it. […] If esophageal content is aspirated when there is reflux, a biochemical analysis can be used to identify the presence of bile in the liquid that refluxated into the esophagus. […] Bile should not be in the esophagus; the presence of bile indicates the presence of bile reflux. […] However, this diagnostic method is not very practical. […] An alternative method, the Bilitec monitoring system, was developed years ago to identify changes in the color of the refluxate in the esophagus.
#3 Bile reflux – Diagnosis & treatment – Mayo Clinic
https://www.mayoclinic.org/diseases-conditions/bile-reflux/diagnosis-treatment/drc-20370121
A description of your symptoms and knowledge of your medical history is usually enough for your doctor to diagnose a reflux problem. But distinguishing between acid reflux and bile reflux is difficult and requires further testing. […] You’re also likely to have tests to check for damage to your esophagus and stomach, as well as for precancerous changes. […] Tests may include: […] Ambulatory acid tests can help your doctor rule out acid reflux but not bile reflux. […] Esophageal impedance. This test measures whether gas or liquids reflux into the esophagus. It’s helpful for people who regurgitate substances that aren’t acidic (such as bile) and can’t be detected by an acid probe. […] Lifestyle adjustments and medications can be very effective for acid reflux into the esophagus, but bile reflux is harder to treat. There is little evidence assessing the effectiveness of bile reflux treatments, in part because of the difficulty of establishing bile reflux as the cause of symptoms.
#4 Bile Reflux: Symptoms, Treatment, Causes & What It Is
https://my.clevelandclinic.org/health/diseases/22056-bile-reflux
Bile reflux occurs when the valves that keep bile from backwashing into your stomach and esophagus arent working properly. Bile reflux occurs when bile from the small intestine backwashes into the stomach, and sometimes into the esophagus. Bile reflux will usually involve abdominal symptoms and sometimes esophagus symptoms. While reflux into your esophagus is easy to diagnose based on your symptoms alone, reflux into your stomach will need to be confirmed by imaging tests. Your healthcare provider will probably order an upper endoscopy exam to look inside of your esophagus, stomach and upper small intestine. The endoscope can take tissue samples while it takes images, to test for inflammation, tissue damage and the presence of bile. […] Symptoms of acid reflux and bile reflux in your esophagus are virtually the same. If your symptoms include vomit, check the color. Bile has a tell-tale yellow tint. If you also have symptoms of bile reflux in your stomach, such as abdominal pain and indigestion, that might be an important clue.
#5 Bile reflux | UM Health-Sparrow
https://www.uofmhealthsparrow.org/departments-conditions/conditions/bile-reflux
Bile reflux may accompany the reflux of stomach acid (gastric acid) into your esophagus. […] Treatment involves medications or, in severe cases, surgery. […] A description of your symptoms and knowledge of your medical history is usually enough for your doctor to diagnose a reflux problem. But distinguishing between acid reflux and bile reflux is difficult and requires further testing. […] You’re also likely to have tests to check for damage to your esophagus and stomach, as well as for precancerous changes. […] Tests may include: […] Endoscopy. A thin, flexible tube with a camera (endoscope) is passed down your throat. The endoscope can show bile, peptic ulcers or inflammation in your stomach and esophagus. Your doctor may also take tissue samples to test for Barrett’s esophagus or esophageal cancer.
#6 Bile reflux // Middlesex Health
https://middlesexhealth.org/learning-center/diseases-and-conditions/bile-reflux
Bile reflux occurs when bile a digestive liquid produced in your liver backs up (refluxes) into your stomach and, in some cases, into the tube that connects your mouth and stomach (esophagus). […] Unlike gastric acid reflux, bile reflux can’t be completely controlled by changes in diet or lifestyle. Treatment involves medications or, in severe cases, surgery. […] A description of your symptoms and knowledge of your medical history is usually enough for your doctor to diagnose a reflux problem. But distinguishing between acid reflux and bile reflux is difficult and requires further testing. […] You’re also likely to have tests to check for damage to your esophagus and stomach, as well as for precancerous changes. […] Tests may include: Endoscopy. A thin, flexible tube with a camera (endoscope) is passed down your throat. The endoscope can show bile, peptic ulcers or inflammation in your stomach and esophagus. Your doctor may also take tissue samples to test for Barrett’s esophagus or esophageal cancer.
#7 Bile reflux | UM Health-Sparrow
https://www.uofmhealthsparrow.org/departments-conditions/conditions/bile-reflux
Bile reflux may accompany the reflux of stomach acid (gastric acid) into your esophagus. […] Treatment involves medications or, in severe cases, surgery. […] A description of your symptoms and knowledge of your medical history is usually enough for your doctor to diagnose a reflux problem. But distinguishing between acid reflux and bile reflux is difficult and requires further testing. […] You’re also likely to have tests to check for damage to your esophagus and stomach, as well as for precancerous changes. […] Tests may include: […] Endoscopy. A thin, flexible tube with a camera (endoscope) is passed down your throat. The endoscope can show bile, peptic ulcers or inflammation in your stomach and esophagus. Your doctor may also take tissue samples to test for Barrett’s esophagus or esophageal cancer.
#8 Bile reflux // Middlesex Health
https://middlesexhealth.org/learning-center/diseases-and-conditions/bile-reflux
Bile reflux occurs when bile a digestive liquid produced in your liver backs up (refluxes) into your stomach and, in some cases, into the tube that connects your mouth and stomach (esophagus). […] Unlike gastric acid reflux, bile reflux can’t be completely controlled by changes in diet or lifestyle. Treatment involves medications or, in severe cases, surgery. […] A description of your symptoms and knowledge of your medical history is usually enough for your doctor to diagnose a reflux problem. But distinguishing between acid reflux and bile reflux is difficult and requires further testing. […] You’re also likely to have tests to check for damage to your esophagus and stomach, as well as for precancerous changes. […] Tests may include: Endoscopy. A thin, flexible tube with a camera (endoscope) is passed down your throat. The endoscope can show bile, peptic ulcers or inflammation in your stomach and esophagus. Your doctor may also take tissue samples to test for Barrett’s esophagus or esophageal cancer.
#9 Bile reflux | UM Health-Sparrow
https://www.uofmhealthsparrow.org/departments-conditions/conditions/bile-reflux
Ambulatory acid tests. These tests use an acid-measuring probe to identify when, and for how long, acid refluxes into your esophagus. Ambulatory acid tests can help your doctor rule out acid reflux but not bile reflux. […] Esophageal impedance. This test measures whether gas or liquids reflux into the esophagus. It’s helpful for people who regurgitate substances that aren’t acidic (such as bile) and can’t be detected by an acid probe. […] Bile reflux is harder to treat. There is little evidence assessing the effectiveness of bile reflux treatments, in part because of the difficulty of establishing bile reflux as the cause of symptoms. […] Doctors may recommend surgery if medications fail to reduce severe symptoms or there are precancerous changes in your stomach or esophagus. […] Some types of surgery can be more successful than others, so be sure to discuss the pros and cons carefully with your doctor.
#10 Bile reflux // Middlesex Health
https://middlesexhealth.org/learning-center/diseases-and-conditions/bile-reflux
Ambulatory acid tests. These tests use an acid-measuring probe to identify when, and for how long, acid refluxes into your esophagus. Ambulatory acid tests can help your doctor rule out acid reflux but not bile reflux. […] In one test, a thin, flexible tube (catheter) with a probe at the end is threaded through your nose into your esophagus. The probe measures the acid in your esophagus over a period of 24 hours. […] In another test called the Bravo test, the probe is attached to the lower portion of your esophagus during endoscopy and the catheter is removed. […] Esophageal impedance. This test measures whether gas or liquids reflux into the esophagus. It’s helpful for people who regurgitate substances that aren’t acidic (such as bile) and can’t be detected by an acid probe. As in a standard probe test, esophageal impedance uses a probe that’s placed into the esophagus with a catheter.
#11 Bile reflux – Diagnosis & treatment – Mayo Clinic
https://www.mayoclinic.org/diseases-conditions/bile-reflux/diagnosis-treatment/drc-20370121
A description of your symptoms and knowledge of your medical history is usually enough for your doctor to diagnose a reflux problem. But distinguishing between acid reflux and bile reflux is difficult and requires further testing. […] You’re also likely to have tests to check for damage to your esophagus and stomach, as well as for precancerous changes. […] Tests may include: […] Ambulatory acid tests can help your doctor rule out acid reflux but not bile reflux. […] Esophageal impedance. This test measures whether gas or liquids reflux into the esophagus. It’s helpful for people who regurgitate substances that aren’t acidic (such as bile) and can’t be detected by an acid probe. […] Lifestyle adjustments and medications can be very effective for acid reflux into the esophagus, but bile reflux is harder to treat. There is little evidence assessing the effectiveness of bile reflux treatments, in part because of the difficulty of establishing bile reflux as the cause of symptoms.
#12 Bile reflux | UM Health-Sparrow
https://www.uofmhealthsparrow.org/departments-conditions/conditions/bile-reflux
Ambulatory acid tests. These tests use an acid-measuring probe to identify when, and for how long, acid refluxes into your esophagus. Ambulatory acid tests can help your doctor rule out acid reflux but not bile reflux. […] Esophageal impedance. This test measures whether gas or liquids reflux into the esophagus. It’s helpful for people who regurgitate substances that aren’t acidic (such as bile) and can’t be detected by an acid probe. […] Bile reflux is harder to treat. There is little evidence assessing the effectiveness of bile reflux treatments, in part because of the difficulty of establishing bile reflux as the cause of symptoms. […] Doctors may recommend surgery if medications fail to reduce severe symptoms or there are precancerous changes in your stomach or esophagus. […] Some types of surgery can be more successful than others, so be sure to discuss the pros and cons carefully with your doctor.
#13 Management of Bile Reflux
https://pmc.ncbi.nlm.nih.gov/articles/PMC3745208/
Bile reflux is very infrequent in healthy individuals. […] This condition is more severe in patients with gastroesophageal reflux disease, particularly those with severe esophagitis and/or Barrett esophagus. […] The first, and most obvious, method of diagnosis is to detect the presence of bile and then measure it. […] If esophageal content is aspirated when there is reflux, a biochemical analysis can be used to identify the presence of bile in the liquid that refluxated into the esophagus. […] Bile should not be in the esophagus; the presence of bile indicates the presence of bile reflux. […] However, this diagnostic method is not very practical. […] An alternative method, the Bilitec monitoring system, was developed years ago to identify changes in the color of the refluxate in the esophagus.
#14 Management of Bile Reflux â Gastroenterology & Hepatology
https://www.gastroenterologyandhepatology.net/archives/march-2013/management-of-bile-reflux/
G&H How is bile reflux usually diagnosed? […] DS The first, and most obvious, method of diagnosis is to detect the presence of bile and then measure it. If esophageal content is aspirated when there is reflux, a biochemical analysis can be used to identify the presence of bile in the liquid that refluxated into the esophagus. Bile should not be in the esophagus; the presence of bile indicates the presence of bile reflux. […] […] […] However, this diagnostic method is not very practical. An alternative method, the Bilitec monitoring system, was developed years ago to identify changes in the color of the refluxate in the esophagus. Because bile has a specific color range, this photo-colorimetric device enables a physician to determine whether there is bile in the refluxate and, if so, how much and for how long it was in the esophagus.
#15
https://link.springer.com/article/10.1007/s11695-023-06632-0
One-anastomosis gastric bypass (OAGB) is a relatively simple surgical procedure for those afflicted with severe obesity. Studies reported symptomatic biliary reflux gastritis and esophagitis as predominant complications. Hepatobiliary scintigraphy (HIDA) is the least invasive test for the diagnosis of bile reflux, with good sensitivity, patient tolerability, and reproducibility. The aim of this study was to define an optimized HIDA scintigraphy protocol for demonstrating bile reflux in post-OAGB patients. […] The tailored HIDA scan protocol detected bile reflux in more than half of the post-OAGB patients included in the study, with a high diagnostic sensitivity.
#16 Bile reflux after bariatric surgery | CirugÃa EspaÃ±ola (English Edition)
https://www.elsevier.es/es-revista-cirugia-espanola-english-edition–436-articulo-bile-reflux-after-bariatric-surgery-S2173507723002235
The growing epidemic of obesity and the increase in weight loss surgery has led to a resurgence of interest in biliary reflux because anatomical alterations may be refluxogenic. […] HIDA scan is the least invasive scan with good patient tolerability, sensitivity and reproducibility for the diagnosis of biliary reflux. […] Patients with more advanced oesophageal lesions have a higher degree of duodenal reflux. It has been shown in animal models and in vitro that there is more Barrett’s and dysplasia with duodenal reflux. […] Validated investigations exist for the diagnosis of acid gastro-oesophageal reflux; however, detection of bile-containing reflux, with subsequent diagnosis of DGOR, is more difficult and there is no accepted gold standard. […] Of the available techniques, HIDA scanning is the least invasive, but provides only a short window for capturing DGOR events.
#17 Management of Bile Reflux â Gastroenterology & Hepatology
https://www.gastroenterologyandhepatology.net/archives/march-2013/management-of-bile-reflux/
G&H How is bile reflux usually diagnosed? […] DS The first, and most obvious, method of diagnosis is to detect the presence of bile and then measure it. If esophageal content is aspirated when there is reflux, a biochemical analysis can be used to identify the presence of bile in the liquid that refluxated into the esophagus. Bile should not be in the esophagus; the presence of bile indicates the presence of bile reflux. […] […] […] However, this diagnostic method is not very practical. An alternative method, the Bilitec monitoring system, was developed years ago to identify changes in the color of the refluxate in the esophagus. Because bile has a specific color range, this photo-colorimetric device enables a physician to determine whether there is bile in the refluxate and, if so, how much and for how long it was in the esophagus.
#18 Diagnostic Principles for Chronic Gastritis Associated with Duodenogastric Reflux
https://www.mdpi.com/2075-4418/13/2/186
Invasive methods of the instrumental diagnosis of BG are aimed at identifying persistent motor disorders and pathological reflux (24 h pH-impedancemetry, hepatobiliary scintigraphy, 24 h monitoring of bilirubin content in the reflux using a Bilitec 2000 photometer), as well as diagnosing gastritis itself (esophagogastroduodenoscopy, morphological gastrobiopsy examination). […] The main method for diagnosing pathological DGR at present is 24 h pH-impedancemetry. […] For the diagnosis of any type of gastritis, conducting an esophagogastroduodenoscopy (EGDS) is mandatory, then followed by the morphological study of the gastrobiopsy specimens. […] There are no pathognomonic macro- or microscopic signs of BG. […] The diagnosis of BG is obtained based on a comprehensive assessment of the objective status and anamnesis data, primarily with regard to concomitant diseases of the biliary tract as well as previous surgical interventions on the abdominal organs that may contribute to the formation of DGR.
#19 Bile reflux – Diagnosis & treatment – Mayo Clinic
https://www.mayoclinic.org/diseases-conditions/bile-reflux/diagnosis-treatment/drc-20370121
A description of your symptoms and knowledge of your medical history is usually enough for your doctor to diagnose a reflux problem. But distinguishing between acid reflux and bile reflux is difficult and requires further testing. […] You’re also likely to have tests to check for damage to your esophagus and stomach, as well as for precancerous changes. […] Tests may include: […] Ambulatory acid tests can help your doctor rule out acid reflux but not bile reflux. […] Esophageal impedance. This test measures whether gas or liquids reflux into the esophagus. It’s helpful for people who regurgitate substances that aren’t acidic (such as bile) and can’t be detected by an acid probe. […] Lifestyle adjustments and medications can be very effective for acid reflux into the esophagus, but bile reflux is harder to treat. There is little evidence assessing the effectiveness of bile reflux treatments, in part because of the difficulty of establishing bile reflux as the cause of symptoms.
#20 Bile reflux can be difficult to diagnosis and treat
https://www.heraldtribune.com/story/news/2009/07/07/bile-reflux-can-be-difficult-to-diagnosis-and-treat/28877526007/
Both acid reflux and bile reflux may afflict the same person, which can make diagnosis a challenge. […] The main diagnostic tests include an endoscopic examination of the esophagus and stomach to check for inflammation or ulceration; a test to check for acid in the esophagus (this would be negative if bile reflux is the only problem), and a test to determine if gas or liquids reflux into the esophagus. […] Surgery is a treatment of last resort, used if nothing else reduces severe symptoms of bile reflux or when the esophagus develops precancerous changes.
#21 Diagnostic Principles for Chronic Gastritis Associated with Duodenogastric Reflux
https://www.mdpi.com/2075-4418/13/2/186
The assessment of the diagnostic possibilities and development mechanisms of BG is extremely relevant not only due to the possible risk of developing atrophy or intestinal metaplasia, but also because of the frequent association of this type of gastritis with a more severe course of gastroesophageal reflux disease. […] For diagnostic purposes it is important to identify the risk factors for BG (female gender, young or old age, asthenic physique, eating habits with excessive consumption of sweets, saturated fats, coarse fiber, obesity, concomitant pathology of the hepatobiliary system, diabetes mellitus, stomach and/or gallbladder surgery, etc.) and to collect the anamnesis of the disease from the emergence of the first symptoms, as well as to clarify the chronological relationship between the identified risk factors and the onset of BG.
#22 Diagnostic Principles for Chronic Gastritis Associated with Duodenogastric Reflux
https://www.mdpi.com/2075-4418/13/2/186
Invasive methods of the instrumental diagnosis of BG are aimed at identifying persistent motor disorders and pathological reflux (24 h pH-impedancemetry, hepatobiliary scintigraphy, 24 h monitoring of bilirubin content in the reflux using a Bilitec 2000 photometer), as well as diagnosing gastritis itself (esophagogastroduodenoscopy, morphological gastrobiopsy examination). […] The main method for diagnosing pathological DGR at present is 24 h pH-impedancemetry. […] For the diagnosis of any type of gastritis, conducting an esophagogastroduodenoscopy (EGDS) is mandatory, then followed by the morphological study of the gastrobiopsy specimens. […] There are no pathognomonic macro- or microscopic signs of BG. […] The diagnosis of BG is obtained based on a comprehensive assessment of the objective status and anamnesis data, primarily with regard to concomitant diseases of the biliary tract as well as previous surgical interventions on the abdominal organs that may contribute to the formation of DGR.
#23 Bile Reflux Gastropathy – Gastritis and Gastropathy – Gastric Diseases – Gastrointestinal Diseases – Gastroenterology – Diseases – McMaster Textbook of Internal Medicine
https://empendium.com/mcmtextbook/chapter/B31.II.4.5.5.
Bile reflux gastropathy may present with dyspepsia, abdominal pain, nausea, vomiting, and weight loss, but it is often asymptomatic. […] Diagnosis is based on endoscopic findings confirmed by histologic findings of a reactive (chemical) gastropathy, characterized by foveolar hyperplasia, mucin cell depletion, and paucity of inflammatory cell infiltrates. […] Endoscopy shows characteristic hyperemia and erythema of the gastric mucosa (often described as a „beefy red stomach” or „red-green stomach”) and, occasionally, mucosal encrustation with bile crystals. […] Despite the dramatic appearance, there is poor correlation between the endoscopic appearance and the patients symptoms, so histologic assessment is warranted to confirm the diagnosis and exclude concomitant Helicobacter pylori infection, which is also associated with an inflammatory infiltrate and requires eradication therapy.
#24 Management of Bile Reflux
https://pmc.ncbi.nlm.nih.gov/articles/PMC3745208/
It has been shown that patients with more bile reflux have more severe esophageal mucosal damage, so there is a clear correlation between the amount of bile reflux and the severity of distal esophageal inflammation. […] In fact, patients with the most severe degree of gastroesophageal inflammation, Barrett esophagus, are those with the largest amount of bile reflux. […] Thus, the importance of bile reflux has to do primarily with the severity of the damage of the esophageal mucosa, the development of Barrett mucosa, and, potentially, the risk of cancer. […] It is known that the more bile reflux a patient has, the higher the risk of Barrett esophagus development; both in vivo and in vitro studies have shown a link between bile that is in contact with esophageal mucosa and changes in the mucosa that are compatible with Barrett esophagus.
#25 Management of Bile Reflux â Gastroenterology & Hepatology
https://www.gastroenterologyandhepatology.net/archives/march-2013/management-of-bile-reflux/
[…] […] G&H Since treatment for bile reflux is the same as treatment for acidic reflux, why is it important to determine whether reflux contains bile? […] DS It has been shown that patients with more bile reflux have more severe esophageal mucosal damage, so there is a clear correlation between the amount of bile reflux and the severity of distal esophageal inflammation. In fact, patients with the most severe degree of gastroesophageal inflammation, Barrett esophagus, are those with the largest amount of bile reflux. Thus, the importance of bile reflux has to do primarily with the severity of the damage of the esophageal mucosa, the development of Barrett mucosa, and, potentially, the risk of cancer. It is known that the more bile reflux a patient has, the higher the risk of Barrett esophagus development; both in vivo and in vitro studies have shown a link between bile that is in contact with esophageal mucosa and changes in the mucosa that are compatible with Barrett esophagus.
#26 Management of Bile Reflux
https://pmc.ncbi.nlm.nih.gov/articles/PMC3745208/
It has been shown that patients with more bile reflux have more severe esophageal mucosal damage, so there is a clear correlation between the amount of bile reflux and the severity of distal esophageal inflammation. […] In fact, patients with the most severe degree of gastroesophageal inflammation, Barrett esophagus, are those with the largest amount of bile reflux. […] Thus, the importance of bile reflux has to do primarily with the severity of the damage of the esophageal mucosa, the development of Barrett mucosa, and, potentially, the risk of cancer. […] It is known that the more bile reflux a patient has, the higher the risk of Barrett esophagus development; both in vivo and in vitro studies have shown a link between bile that is in contact with esophageal mucosa and changes in the mucosa that are compatible with Barrett esophagus.
#27 Management of Bile Reflux â Gastroenterology & Hepatology
https://www.gastroenterologyandhepatology.net/archives/march-2013/management-of-bile-reflux/
[…] […] G&H Since treatment for bile reflux is the same as treatment for acidic reflux, why is it important to determine whether reflux contains bile? […] DS It has been shown that patients with more bile reflux have more severe esophageal mucosal damage, so there is a clear correlation between the amount of bile reflux and the severity of distal esophageal inflammation. In fact, patients with the most severe degree of gastroesophageal inflammation, Barrett esophagus, are those with the largest amount of bile reflux. Thus, the importance of bile reflux has to do primarily with the severity of the damage of the esophageal mucosa, the development of Barrett mucosa, and, potentially, the risk of cancer. It is known that the more bile reflux a patient has, the higher the risk of Barrett esophagus development; both in vivo and in vitro studies have shown a link between bile that is in contact with esophageal mucosa and changes in the mucosa that are compatible with Barrett esophagus.
#28 Management of Bile Reflux
https://pmc.ncbi.nlm.nih.gov/articles/PMC3745208/
It has been shown that patients with more bile reflux have more severe esophageal mucosal damage, so there is a clear correlation between the amount of bile reflux and the severity of distal esophageal inflammation. […] In fact, patients with the most severe degree of gastroesophageal inflammation, Barrett esophagus, are those with the largest amount of bile reflux. […] Thus, the importance of bile reflux has to do primarily with the severity of the damage of the esophageal mucosa, the development of Barrett mucosa, and, potentially, the risk of cancer. […] It is known that the more bile reflux a patient has, the higher the risk of Barrett esophagus development; both in vivo and in vitro studies have shown a link between bile that is in contact with esophageal mucosa and changes in the mucosa that are compatible with Barrett esophagus.
#29 Management of Bile Reflux â Gastroenterology & Hepatology
https://www.gastroenterologyandhepatology.net/archives/march-2013/management-of-bile-reflux/
[…] […] G&H Since treatment for bile reflux is the same as treatment for acidic reflux, why is it important to determine whether reflux contains bile? […] DS It has been shown that patients with more bile reflux have more severe esophageal mucosal damage, so there is a clear correlation between the amount of bile reflux and the severity of distal esophageal inflammation. In fact, patients with the most severe degree of gastroesophageal inflammation, Barrett esophagus, are those with the largest amount of bile reflux. Thus, the importance of bile reflux has to do primarily with the severity of the damage of the esophageal mucosa, the development of Barrett mucosa, and, potentially, the risk of cancer. It is known that the more bile reflux a patient has, the higher the risk of Barrett esophagus development; both in vivo and in vitro studies have shown a link between bile that is in contact with esophageal mucosa and changes in the mucosa that are compatible with Barrett esophagus.
#30 Bile reflux – Diagnosis & treatment – Mayo Clinic
https://www.mayoclinic.org/diseases-conditions/bile-reflux/diagnosis-treatment/drc-20370121
A description of your symptoms and knowledge of your medical history is usually enough for your doctor to diagnose a reflux problem. But distinguishing between acid reflux and bile reflux is difficult and requires further testing. […] You’re also likely to have tests to check for damage to your esophagus and stomach, as well as for precancerous changes. […] Tests may include: […] Ambulatory acid tests can help your doctor rule out acid reflux but not bile reflux. […] Esophageal impedance. This test measures whether gas or liquids reflux into the esophagus. It’s helpful for people who regurgitate substances that aren’t acidic (such as bile) and can’t be detected by an acid probe. […] Lifestyle adjustments and medications can be very effective for acid reflux into the esophagus, but bile reflux is harder to treat. There is little evidence assessing the effectiveness of bile reflux treatments, in part because of the difficulty of establishing bile reflux as the cause of symptoms.
#31 Bile reflux can be difficult to diagnosis and treat
https://www.heraldtribune.com/story/news/2009/07/07/bile-reflux-can-be-difficult-to-diagnosis-and-treat/28877526007/
Both acid reflux and bile reflux may afflict the same person, which can make diagnosis a challenge. […] The main diagnostic tests include an endoscopic examination of the esophagus and stomach to check for inflammation or ulceration; a test to check for acid in the esophagus (this would be negative if bile reflux is the only problem), and a test to determine if gas or liquids reflux into the esophagus. […] Surgery is a treatment of last resort, used if nothing else reduces severe symptoms of bile reflux or when the esophagus develops precancerous changes.
#32 Bile Reflux: Symptoms, Treatment, Causes & What It Is
https://my.clevelandclinic.org/health/diseases/22056-bile-reflux
Bile reflux occurs when the valves that keep bile from backwashing into your stomach and esophagus arent working properly. Bile reflux occurs when bile from the small intestine backwashes into the stomach, and sometimes into the esophagus. Bile reflux will usually involve abdominal symptoms and sometimes esophagus symptoms. While reflux into your esophagus is easy to diagnose based on your symptoms alone, reflux into your stomach will need to be confirmed by imaging tests. Your healthcare provider will probably order an upper endoscopy exam to look inside of your esophagus, stomach and upper small intestine. The endoscope can take tissue samples while it takes images, to test for inflammation, tissue damage and the presence of bile. […] Symptoms of acid reflux and bile reflux in your esophagus are virtually the same. If your symptoms include vomit, check the color. Bile has a tell-tale yellow tint. If you also have symptoms of bile reflux in your stomach, such as abdominal pain and indigestion, that might be an important clue.
#33 Bile Reflux: Symptoms, Treatment, Causes & What It Is
https://my.clevelandclinic.org/health/diseases/22056-bile-reflux
Bile reflux occurs when the valves that keep bile from backwashing into your stomach and esophagus arent working properly. Bile reflux occurs when bile from the small intestine backwashes into the stomach, and sometimes into the esophagus. Bile reflux will usually involve abdominal symptoms and sometimes esophagus symptoms. While reflux into your esophagus is easy to diagnose based on your symptoms alone, reflux into your stomach will need to be confirmed by imaging tests. Your healthcare provider will probably order an upper endoscopy exam to look inside of your esophagus, stomach and upper small intestine. The endoscope can take tissue samples while it takes images, to test for inflammation, tissue damage and the presence of bile. […] Symptoms of acid reflux and bile reflux in your esophagus are virtually the same. If your symptoms include vomit, check the color. Bile has a tell-tale yellow tint. If you also have symptoms of bile reflux in your stomach, such as abdominal pain and indigestion, that might be an important clue.
#34 Bile reflux – Symptoms & causes – Mayo Clinic
https://www.mayoclinic.org/diseases-conditions/bile-reflux/symptoms-causes/syc-20370115
People who have had their gallbladders removed have significantly more bile reflux than do people who haven’t had this surgery. […] Bile reflux gastritis has been linked to stomach cancer. […] The combination of bile reflux and acid reflux also increases the risk of the following complications: […] Bile is often suspected of contributing to GERD when people respond incompletely or not at all to powerful acid-suppressant medications. […] There’s a link between acid reflux and bile reflux and esophageal cancer, which may not be diagnosed until it’s quite advanced.
#35 Bile reflux – Diagnosis & treatment – Mayo Clinic
https://www.mayoclinic.org/diseases-conditions/bile-reflux/diagnosis-treatment/drc-20370121
A description of your symptoms and knowledge of your medical history is usually enough for your doctor to diagnose a reflux problem. But distinguishing between acid reflux and bile reflux is difficult and requires further testing. […] You’re also likely to have tests to check for damage to your esophagus and stomach, as well as for precancerous changes. […] Tests may include: […] Ambulatory acid tests can help your doctor rule out acid reflux but not bile reflux. […] Esophageal impedance. This test measures whether gas or liquids reflux into the esophagus. It’s helpful for people who regurgitate substances that aren’t acidic (such as bile) and can’t be detected by an acid probe. […] Lifestyle adjustments and medications can be very effective for acid reflux into the esophagus, but bile reflux is harder to treat. There is little evidence assessing the effectiveness of bile reflux treatments, in part because of the difficulty of establishing bile reflux as the cause of symptoms.
#36 Bile reflux | UM Health-Sparrow
https://www.uofmhealthsparrow.org/departments-conditions/conditions/bile-reflux
Ambulatory acid tests. These tests use an acid-measuring probe to identify when, and for how long, acid refluxes into your esophagus. Ambulatory acid tests can help your doctor rule out acid reflux but not bile reflux. […] Esophageal impedance. This test measures whether gas or liquids reflux into the esophagus. It’s helpful for people who regurgitate substances that aren’t acidic (such as bile) and can’t be detected by an acid probe. […] Bile reflux is harder to treat. There is little evidence assessing the effectiveness of bile reflux treatments, in part because of the difficulty of establishing bile reflux as the cause of symptoms. […] Doctors may recommend surgery if medications fail to reduce severe symptoms or there are precancerous changes in your stomach or esophagus. […] Some types of surgery can be more successful than others, so be sure to discuss the pros and cons carefully with your doctor.
#37 Bile reflux – Diagnosis & treatment – Mayo Clinic
https://www.mayoclinic.org/diseases-conditions/bile-reflux/diagnosis-treatment/drc-20370121
Doctors may recommend surgery if medications fail to reduce severe symptoms or there are precancerous changes in your stomach or esophagus. […] However, there’s little evidence about the surgery’s effectiveness for bile reflux. […] Make an appointment with your doctor if you have signs or symptoms common to bile reflux.
#38 Bile reflux // Middlesex Health
https://middlesexhealth.org/learning-center/diseases-and-conditions/bile-reflux
Lifestyle adjustments and medications can be very effective for acid reflux into the esophagus, but bile reflux is harder to treat. There is little evidence assessing the effectiveness of bile reflux treatments, in part because of the difficulty of establishing bile reflux as the cause of symptoms. […] Doctors may recommend surgery if medications fail to reduce severe symptoms or there are precancerous changes in your stomach or esophagus. […] Some types of surgery can be more successful than others, so be sure to discuss the pros and cons carefully with your doctor.
#39 Bile reflux // Middlesex Health
https://middlesexhealth.org/learning-center/diseases-and-conditions/bile-reflux
Lifestyle adjustments and medications can be very effective for acid reflux into the esophagus, but bile reflux is harder to treat. There is little evidence assessing the effectiveness of bile reflux treatments, in part because of the difficulty of establishing bile reflux as the cause of symptoms. […] Doctors may recommend surgery if medications fail to reduce severe symptoms or there are precancerous changes in your stomach or esophagus. […] Some types of surgery can be more successful than others, so be sure to discuss the pros and cons carefully with your doctor.
#40 Bile reflux can be difficult to diagnosis and treat
https://www.heraldtribune.com/story/news/2009/07/07/bile-reflux-can-be-difficult-to-diagnosis-and-treat/28877526007/
Both acid reflux and bile reflux may afflict the same person, which can make diagnosis a challenge. […] The main diagnostic tests include an endoscopic examination of the esophagus and stomach to check for inflammation or ulceration; a test to check for acid in the esophagus (this would be negative if bile reflux is the only problem), and a test to determine if gas or liquids reflux into the esophagus. […] Surgery is a treatment of last resort, used if nothing else reduces severe symptoms of bile reflux or when the esophagus develops precancerous changes.
#41 Management of Bile Reflux
https://pmc.ncbi.nlm.nih.gov/articles/PMC3745208/
There are 3 main lines of research in this area. One is related to the impact of bile acids and bile salts in the esophageal mucosa and the development of Barrett esophagus and cancer. […] The second line of research involves the role of bile reflux in extraesophageal syndromes related to reflux (eg, the development of respiratory disorders associated with reflux). […] The third line of research involves the role of bile in the pathogenesis of nonerosive reflux disease and symptoms.
#42 Management of Bile Reflux â Gastroenterology & Hepatology
https://www.gastroenterologyandhepatology.net/archives/march-2013/management-of-bile-reflux/
[…] […] However, there is no need for patients with bile reflux to undergo special monitoring or take any prophylactic measures (apart from treatment of gastroesophageal reflux disease) unless they already have Barrett esophagus. Even in this case, endoscopic surveillance is controversial if the Barrett mucosa shows no signs of dysplasia. […] […] […] G&H What are the next steps of research in this area? […] DS There are 3 main lines of research in this area. One is related to the impact of bile acids and bile salts in the esophageal mucosa and the development of Barrett esophagus and cancer. The second line of research involves the role of bile reflux in extraesophageal syndromes related to reflux (eg, the development of respiratory disorders associated with reflux). There is some evidence that the presence of bile in the aspiration of refluxate into the airways might be very important in the development of respiratory disorders. This is a marker of aspiration as well as a very important inflammatory component that can trigger inflammation. This is true for patients with reflux who have undergone lung transplantation and patients with cystic fibrosis. Thus, the appearance of bile in respiratory secretions is not only considered a marker, but it can also be pathogenic in the respiratory disorder. The third line of research involves the role of bile in the pathogenesis of nonerosive reflux disease and symptoms. It is known that patients who have persistent symptoms such as heartburn or regurgitation may have refluxate that contains bile acid despite receiving proton pump inhibitor therapy (because proton pump inhibitors do not reduce the presence of bile acid). Bile acids might have an impact on the esophageal mucosa of patients with nonerosive reflux disease and might be related to the persistence of symptoms in these patients.
#43
https://link.springer.com/article/10.1007/s11695-023-06632-0
One-anastomosis gastric bypass (OAGB) is a relatively simple surgical procedure for those afflicted with severe obesity. Studies reported symptomatic biliary reflux gastritis and esophagitis as predominant complications. Hepatobiliary scintigraphy (HIDA) is the least invasive test for the diagnosis of bile reflux, with good sensitivity, patient tolerability, and reproducibility. The aim of this study was to define an optimized HIDA scintigraphy protocol for demonstrating bile reflux in post-OAGB patients. […] The tailored HIDA scan protocol detected bile reflux in more than half of the post-OAGB patients included in the study, with a high diagnostic sensitivity.
#44 Diagnostic Principles for Chronic Gastritis Associated with Duodenogastric Reflux
https://www.mdpi.com/2075-4418/13/2/186
Invasive methods of the instrumental diagnosis of BG are aimed at identifying persistent motor disorders and pathological reflux (24 h pH-impedancemetry, hepatobiliary scintigraphy, 24 h monitoring of bilirubin content in the reflux using a Bilitec 2000 photometer), as well as diagnosing gastritis itself (esophagogastroduodenoscopy, morphological gastrobiopsy examination). […] The main method for diagnosing pathological DGR at present is 24 h pH-impedancemetry. […] For the diagnosis of any type of gastritis, conducting an esophagogastroduodenoscopy (EGDS) is mandatory, then followed by the morphological study of the gastrobiopsy specimens. […] There are no pathognomonic macro- or microscopic signs of BG. […] The diagnosis of BG is obtained based on a comprehensive assessment of the objective status and anamnesis data, primarily with regard to concomitant diseases of the biliary tract as well as previous surgical interventions on the abdominal organs that may contribute to the formation of DGR.
#45 Bile reflux after bariatric surgery | CirugÃa EspaÃ±ola (English Edition)
https://www.elsevier.es/es-revista-cirugia-espanola-english-edition–436-articulo-bile-reflux-after-bariatric-surgery-S2173507723002235
The growing epidemic of obesity and the increase in weight loss surgery has led to a resurgence of interest in biliary reflux because anatomical alterations may be refluxogenic. […] HIDA scan is the least invasive scan with good patient tolerability, sensitivity and reproducibility for the diagnosis of biliary reflux. […] Patients with more advanced oesophageal lesions have a higher degree of duodenal reflux. It has been shown in animal models and in vitro that there is more Barrett’s and dysplasia with duodenal reflux. […] Validated investigations exist for the diagnosis of acid gastro-oesophageal reflux; however, detection of bile-containing reflux, with subsequent diagnosis of DGOR, is more difficult and there is no accepted gold standard. […] Of the available techniques, HIDA scanning is the least invasive, but provides only a short window for capturing DGOR events.
#46 Bile Reflux Gastritis: Insights into Pathogenesis, Relevant Factors, Carcinomatous Risk, Diagnosis, and Management â ScienceOpen
https://www.scienceopen.com/document/read?vid=aa45c09f-ed58-47b2-a4b8-0fc9dd756e51
Bile reflux gastritis (BRG), a kind of gastrointestinal disorder in clinical practice, is characterized by regurgitation and inflammation. […] Till now, there is still no golden standard for diagnosis of BRG. Nevertheless, advances in techniques, especially extensive applications of endoscopy and chemical analysis of reflux contents, have improved our ability to identify the occurrence of this disease as well as distinguishing physiological reflux from pathological reflux. […] The diagnosis of bile reflux gastritis is still challenging for its atypical clinical symptoms and nonspecific auxiliary examinations. Patients with BRG often complain of abdominal pain, dyspepsia, nausea with bilious vomiting, bitter taste, poor appetite, and heartburn while some patients even do not have symptoms. Additionally, the severity of these symptoms was not found to be proportional to the amount of bile in the reflux.
#47 Bile Reflux Gastritis: Insights into Pathogenesis, Relevant Factors, Carcinomatous Risk, Diagnosis, and Management â ScienceOpen
https://www.scienceopen.com/document/read?vid=aa45c09f-ed58-47b2-a4b8-0fc9dd756e51
Bile reflux gastritis (BRG), a kind of gastrointestinal disorder in clinical practice, is characterized by regurgitation and inflammation. […] Till now, there is still no golden standard for diagnosis of BRG. Nevertheless, advances in techniques, especially extensive applications of endoscopy and chemical analysis of reflux contents, have improved our ability to identify the occurrence of this disease as well as distinguishing physiological reflux from pathological reflux. […] The diagnosis of bile reflux gastritis is still challenging for its atypical clinical symptoms and nonspecific auxiliary examinations. Patients with BRG often complain of abdominal pain, dyspepsia, nausea with bilious vomiting, bitter taste, poor appetite, and heartburn while some patients even do not have symptoms. Additionally, the severity of these symptoms was not found to be proportional to the amount of bile in the reflux.
#48 Biliary reflux after bariatric surgery and after gastroesophageal surgery for gastroesophageal reflux disease – Marabotto – Digestive Medicine Research
https://dmr.amegroups.org/article/view/9258/html
Biliary reflux refers to the ascent of duodenal fluid, biliary and pancreatic secretions into the stomach and esophagus. […] Current data show that the prevalence of biliary reflux was higher after minigastric bypass as compared to the other bariatric surgeries. […] Its evaluation is challenging, and several methods have been proposed to date. Hepatobiliary iminodiacetic acid (HIDA) assessment is a non-invasive technique which showed a good correlation with gastric bile acids in several clinical investigations. […] Impedance-pH monitoring has been shown to correctly identify non-acidic reflux, but it is not considered a valid tool to diagnose the occurrence of bile reflux episodes in the esophagus since its inability to distinguish bile from other non-acidic components of the refluxate like food.
#49 Diagnostic Principles for Chronic Gastritis Associated with Duodenogastric Reflux
https://www.mdpi.com/2075-4418/13/2/186
This article systematizes available data from the literature on biliary gastritis (BG) in order to increase the awareness of specialists about the latest possibilities for diagnosing the disease. […] Diagnostic methods for BG are carried out to identify risk factors, exclude alarm symptoms and identify persistent motor disorders and pathological reflux (24 h pH-impedancemetry, hepatobiliary scintigraphy, 24 h monitoring of bilirubin content in the reflux using a Bilitec 2000 photometer), as well as to diagnose gastritis itself (esophagogastroduodenoscopy, morphological gastrobiopsy examination). […] The diagnosis of BG should be based on a multidisciplinary approach that combines a thorough analysis of a patientâs complaints, an anamnesis of the disease, and the results of endoscopic and histological research methods.
#50 Bile reflux after bariatric surgery | CirugÃa EspaÃ±ola (English Edition)
https://www.elsevier.es/es-revista-cirugia-espanola-english-edition–436-articulo-bile-reflux-after-bariatric-surgery-S2173507723002235
At present, although there is no gold standard, the HIDA scan is the least invasive scan, with good patient tolerability, sensitivity and reproducibility to be considered first-line for the diagnosis of bile reflux. […] The HIDA scan is a sensitive measure of remnant pathology and is a readily available non-invasive test. HIDA and endoscopic biopsies are highly suggestive of biliary reflux remnant gastritis.
#51 Bile Reflux: Clinical Considerations – Gastroenterology Advisor
https://www.gastroenterologyadvisor.com/features/tips-for-distinguishing-and-treating-biliary-reflux/
The authors concluded that duodeno-gastric bile reflux was present in at least 1/3 of patients with functional dyspepsia. […] There are no formal guidelines for treating patients with DGER; therefore, they are typically treated similarly to those with traditional GERD. […] When PPIs are used to treat DGER, the mechanism may be secondary to reducing gastric acid volume and overall acidity, although the alkaline nature of the bile reflux can still cause irritation of the esophagus. […] In addition, DGER should be considered in patients with persistent GERD symptoms, despite maximum PPI dosing. […] As with refractory GERD, surgery can also be considered in those patients with DGER who fail medical management.
#52 Biliary reflux after bariatric surgery and after gastroesophageal surgery for gastroesophageal reflux disease – Marabotto – Digestive Medicine Research
https://dmr.amegroups.org/article/view/9258/html
Fibreoptic spectrophotometric probe (Bilitec) was proposed to quantify bile reflux in an ambulatory setting and over a prolonged period, using bilirubin as a marker for the presence of duodenal contents. […] The prevalence of biliary reflux after bariatric surgeries has been heterogeneously reported in a number of studies. […] Notably, the reported prevalence of biliary reflux was higher after MGB as compared to the other bariatric surgeries and when HIDA was used to measure biliary reflux as compared to endoscopy and gastric pouch biopsies. […] Few studies have addressed the impact of antireflux surgery, particularly the Nissen Fundoplication, on the neutralization of biliary reflux. […] Anti-reflux procedures appear to be efficient to control biliary reflux, mainly Nissen Fundoplication.
#53 Reflux â Acid or Bile? Know the difference | Gastrointestinal Associates
https://gihealthcare.com/reflux-acid-or-bile-know-the-difference/
How is bile reflux diagnosed? […] Because the symptoms of acid reflux and bile reflux are so similar, it is impossible to make a diagnosis of bile reflux based on symptoms alone. Common tests include an endoscopy, where a thin, flexible tube with a camera is passed down your throat; a test to check for acid in the esophagus; and/or tests to determine if gas or liquids are backing up into the esophagus. […] The most important thing to remember is this: If you are suffering from chronic heartburn or other symptoms listed in the post, it is time to see your physician for a proper diagnosis and treatment plan.
#54 Is Bile Reflux Dangerous? Explore the Symptoms & Treatments Is Bile Reflux Dangerous? Explore the Symptoms & Treatments
https://www.refluxguard.com/bile-reflux/?srsltid=AfmBOoqiciq_D4GlZ1PDkKrOsRtni9njlBi3wQX7di939n1zj-BncxXO
Once bile reflux has been identified, treatment generally involves taking a medication like Ursodiol, which helps your body more easily move bile through the intestines, reducing the risk of backflow (refluxing). […] If medication is ineffective, surgery may be the next step. Three procedures are commonly used to treat bile reflux: Roux-en-Y diversion surgery, fundoplication, and Linx implant. […] If youâre having any of the symptoms explored above, especially if you are currently undergoing treatment for acid reflux that is not proving effective, it is important to contact your doctor right away. […] Chronic episodes of the symptoms listed above should prompt a visit to your doctor.