Fiorucci S, Distrutti E, Di Matteo F, Brunori P, Santucci L, Mallozzi E, Bigazzi U, Morelli A
Dipartimento di Medicina Clinica, Farmacologia e Patologia, Universita degli Studi di Perugia, Italy.
Am J Gastroenterol. 1995 Feb;90(2):270-6.
Duodenogastric reflux is a physiological phenomenon in both fasting and postprandial state. Because this suggests that bile acids may reflux into the esophagus together with the acid in patients with reflux esophagitis, we investigated the circadian variations of acid and pepsin secretion and intragastric bile acid concentrations in 25 patients with reflux esophagitis and in 15 healthy controls.
Between-meal, nocturnal gastric and meal-stimulated acid and pepsin secretion and bile acid concentrations were measured by continuous gastric aspiration and intragastric titration.
Bile acids were found in 85 and 59% of gastric samples (p < 0.05). Intragastric bile acid concentrations were 6-8-fold higher in esophagitis patients than controls during the day. Approximately 10% of gastric samples from reflux esophagitis patients had a pH greater than 7, and all contained more than 500 mumol/L bile acids. Bile acids and pepsin were simultaneously revealed in 98% of the gastric samples from patients with reflux esophagitis with pH less than 4. Mean daily acid output (meal excluded) averaged 3.5 +/- 0.1 in healthy subjects and 2.7 +/- 0.2 mmol/30 minutes in esophagitis patients (p < 0.05); meal-induced acid secretions were similar. Total (24-h) acid secretion averaged 192.3 +/- 12.4 and 162.4 +/- 10.5 mmol/24 h (p < 0.05). There were no differences in the daily pepsin output.
Our data indicate that almost all "acid" gastroesophageal refluxes should be considered as "mixed" refluxes. Because bile acids are found in the stomach irrespective of whether the environment was acid or alkaline, pH-metry provides no useful information on the pattern of duodenogastric reflux into the esophagus. Variability in the composition of the gastro-esophageal refluxate may explain why the severity of esophageal lesions differs in patients with similar pattern of acid refluxes.
十二指肠-胃反流在空腹和餐后状态下均为一种生理现象。鉴于此提示反流性食管炎患者胆汁酸可能与胃酸一同反流至食管，我们对25例反流性食管炎患者及15名健康对照者的胃酸和胃蛋白酶分泌的昼夜变化以及胃内胆汁酸浓度进行了研究。
通过持续胃抽吸及胃内滴定法测量餐间、夜间胃内以及进餐刺激后的胃酸、胃蛋白酶分泌及胆汁酸浓度。
在85%和59%的胃样本中发现了胆汁酸（p<0.05）。白天，食管炎患者胃内胆汁酸浓度比对照组高6至8倍。反流性食管炎患者约10%的胃样本pH值大于7，且所有样本中胆汁酸含量均超过500μmol/L。pH值小于4的反流性食管炎患者98%的胃样本中同时检测到胆汁酸和胃蛋白酶。健康受试者平均每日酸排出量（不包括进餐时）为3.5±0.1，食管炎患者为2.7±0.2mmol/30分钟（p<0.05）；进餐诱导的酸分泌相似。总（24小时）酸分泌平均为192.3±12.4和162.4±10.5mmol/24小时（p<0.05）。每日胃蛋白酶排出量无差异。
我们的数据表明，几乎所有的“酸性”胃食管反流都应被视为“混合性”反流。因为无论胃内环境是酸性还是碱性，均能检测到胆汁酸，所以pH测定对于十二指肠-胃反流至食管的模式并无有用信息。胃食管反流物成分的变异性可能解释了为何具有相似胃酸反流模式的患者食管病变严重程度不同。
