Wolfgarten Eva, Pütz Benito, Hölscher Arnulf H, Bollschweiler Elfriede
Department of Visceral and Vascular Surgery, University of Cologne, Cologne, Germany.
J Gastrointest Surg. 2007 Apr;11(4):479-86. doi: 10.1007/s11605-006-0017-7.
The aim of the study was to analyse pH- and bile-monitoring data in patients with Barrett's esophagus and in age- and gender-matched controls.
Twenty-four consecutive Barrett's patients (8 females, 16 males, mean age 57 years), 21 patients with esophagitis (10 females, 11 males, mean age 58 years), and 19 healthy controls (8 females, 11 males, mean age 51 years), were included. Only patients underwent endoscopy with biopsy. All groups were investigated with manometry, gastric and esophageal 24-h pH, and simultaneous bile monitoring according to a standardized protocol. A bilirubin absorption>0.25 was determined as noxious bile reflux. The receiver operator characteristic (ROC) method was applied to determine the optimal cutoff value of pathologic bilirubin levels.
Of Barrett's patients, 79% had pathologic acidic gastric reflux (pH<4>5% of total measuring time). However, 32% of healthy controls also had acid reflux (p<0.05) without any symptoms. The median of esophageal bile reflux was 7.8% (lower quartile (LQ)-upper quartile (UQ)=1.6-17.8%) in Barrett's patients, in patients with esophagitis, 3.5% (LQ-UQ=0.1-13.5), and in contrast to 0% (LQ-UQ=0-1.0%) in controls, p=0.001. ROC analysis showed the optimal dividing value for patients at more than 1% bile reflux over 24 h (75% sensitivity, 84% specificity).
An optimal threshold to differentiate between normal and pathological bile reflux into the esophagus is 1% (24-h bile monitoring with an absorbance>0.25).
本研究的目的是分析巴雷特食管患者以及年龄和性别匹配的对照组的pH值和胆汁监测数据。
纳入了24例连续的巴雷特食管患者（8例女性，16例男性，平均年龄57岁）、21例食管炎患者（10例女性，11例男性，平均年龄58岁）和19例健康对照者（8例女性，11例男性，平均年龄51岁）。仅患者接受了内镜活检。所有组均按照标准化方案进行测压、胃和食管24小时pH值监测以及同步胆汁监测。胆红素吸收>0.25被确定为有害胆汁反流。采用受试者操作特征（ROC）方法确定病理性胆红素水平的最佳截断值。
巴雷特食管患者中，79%有病理性酸性胃反流（pH<4>5%的总测量时间）。然而，32%的健康对照者也有酸反流（p<0.05），但无任何症状。巴雷特食管患者食管胆汁反流的中位数为7.8%（下四分位数（LQ）-上四分位数（UQ）=1.6-17.8%），食管炎患者为3.5%（LQ-UQ=0.1-13.5%），而对照组为0%（LQ-UQ=0-1.0%），p=0.001。ROC分析显示，24小时胆汁反流超过1%的患者的最佳分界值（敏感性75%，特异性84%）。
区分正常和病理性食管胆汁反流的最佳阈值是1%（24小时胆汁监测，吸光度>0.25）。
