Gastric bilirubin monitoring to assess duodenogastric reflux.

Duodenogastric reflux (DGR) was assessed with 24-hour gastric bilirubin monitoring in 345 patients (219 men; 49 +/- 13 years) with foregut symptoms and 41 healthy subjects (24 men, 28 +/- 5 years). Bilirubin exposure was measured as percent time above absorbance level 0.25 and excessive DGR was defined above the 95th percentile of normal values (>24.8%). DGR was highest following Billroth II gastric resection (60 +/- 24%, N = 15). Patients after cholecystectomy (28 +/- 25%, N = 25), patients with gastroesophageal reflux disease (24 +/- 24%, N = 199), and patients with nonulcer dyspepsia (23 +/- 21%, N = 61) had a significantly higher exposure to DGR than healthy subjects (7 +/- 8%, P < 0.0001). In conclusion, gastric bilirubin monitoring is useful for the assessment of DGR specifically in symptomatic patients following gastric resection. Increased amounts of DGR may further be of clinical importance in patients with reflux disease or nonulcer dyspepsia and following cholecystectomy.