Effect of bile salts and related compounds on esophageal mucosa.

Several potentially harmful agents present in the gastric juice or duodenal contents were assessed in terms of their ability to cause damage to the esophageal mucosa using an in vitro technique. In the presence of luminal acid (pH 3.5), taurocholate and pepsin and, to a lesser degree, lysolecithin adversely affected the mucosa causing increased diffusion of luminal H+ into the mucosa, a mechanism which may play a significant role in the pathogenesis of acidic reflux esophagitis. In the absence of luminal acid (pH 7.4) trypsin and the deconjugated bile salts cholate, chenodeoxycholate and deoxycholate affected the mucosa and possibly play a more important role in the pathogenesis of alkaline reflux esophagitis.