Stein H J, Kraemer S J, Feussner H, Siewert J R
Chirurgische Klinik und Poliklinik, Technische Universität München.
Z Gastroenterol. 1994 May;32(5):247-51.
Currently available methods to assess reflux of duodenal contents into the esophagus are cumbersome, unphysiologic, and inaccurate. The role of intestino-esophageal reflux has therefore been controversial. We assessed intestino-esophageal reflux using a new system which allows prolonged intraesophageal measurement of bilirubin, the major pigment of bile. Measurements were made with a newly developed fiber-optic sensor electrode connected to a portable data processing unit (BILITEC 2000, Synectics Medical Inc., Sweden). Light absorption was measured at the absorption peak of bilirubin and a reference point. Studies were performed in 9 subjects without esophagitis, 9 subjects with esophagitis and primary reflux disease and 7 subjects with erosive esophagitis after a total or subtotal gastrectomy. The fiberoptic electrode was placed 5 cm above the lower esophageal sphincter. In vitro studies showed linear correlations between absorbance measurements obtained with the BILITEC-unit and known bilirubin and bile acid concentrations, respectively (p < 0.01). Compared to both other groups, light absorption was markedly increased in the subjects who had esophagitis after a total or subtotal gastrectomy (p < 0.05) indicating severe biliary reflux. An increase in bilirubin absorption occurred particularly during the post-prandial and supine periodes (p < 0.01). A Roux-en-Y biliary diversion procedure completely abolished bile reflux in 2 of these patients. These data indicate that ambulatory 24-hour fiberoptic measurement of bilirubin in the esophagus is feasible and allows quantitation of intestino-esophageal reflux. Intestino-esophageal reflux occurs particularly during the postprandial period and the early morning hours in patients who had a previous subtotal or total gastrectomy.
目前用于评估十二指肠内容物反流至食管的方法既繁琐、不符合生理情况，又不准确。因此，肠食管反流的作用一直存在争议。我们使用一种新系统评估肠食管反流，该系统可对胆汁的主要色素胆红素进行长时间的食管内测量。测量是通过一个新开发的光纤传感电极进行的，该电极连接到一个便携式数据处理单元（BILITEC 2000，瑞典Synectics Medical公司）。在胆红素的吸收峰和一个参考点处测量光吸收。对9名无食管炎的受试者、9名患有食管炎和原发性反流疾病的受试者以及7名全胃或次全胃切除术后患有糜烂性食管炎的受试者进行了研究。将光纤电极放置在食管下括约肌上方5厘米处。体外研究表明，用BILITEC装置获得的吸光度测量值分别与已知的胆红素和胆汁酸浓度之间存在线性相关性（p<0.01）。与其他两组相比，全胃或次全胃切除术后患有食管炎的受试者的光吸收明显增加（p<0.05），表明存在严重的胆汁反流。胆红素吸收增加尤其发生在餐后和仰卧期（p<0.01）。Roux-en-Y胆肠分流术使其中2例患者的胆汁反流完全消失。这些数据表明，食管内胆红素的动态24小时光纤测量是可行的，并且可以对肠食管反流进行定量。肠食管反流尤其发生在既往有次全胃或全胃切除术的患者的餐后和清晨时段。
