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Title: Role of duodenogastroesophageal reflux in the pathogenesis of esophageal mucosal injury and gastroesophageal reflux symptoms
Authors: Xu, XR
Li, ZS
Zou, DW
Xu, GM
Ye, P
Sun, ZX
Wang Q 
Zeng, YJ
Keywords: Bilirubin monitoring
Duodenogastroesophageal reflux
Gastroesophageal reflux disease
Nonerosive reflux disease
pH monitoring
Issue Date: 2006
Publisher: Hindawi Publishing Corporation
Source: Canadian journal of gastroenterology, 2006, v. 20, no. 2, p. 91-94 How to cite?
Journal: Canadian journal of gastroenterology 
Abstract: Background and aim: Patients with gastroesophageal flux disease (GERD) usually suffer from acid reflux and duodenogastroesophageal reflux (DGER) simultaneously. The question of whether DGER has an important effect on the development of GERD remains controversial. The aim of the present study was to investigate the role of DGER in the pathogenesis of GERD and its value for the diagnosis of nonerosive reflux disease (NERD).
Methods: GERD was initially diagnosed using the reflux disease questionnaire. For further diagnosis, results of the upper gastrointestinal endoscopy (excluding a diagnosis of Barrett's esophagus) were considered in conjunction with simultaneous 24 h esophageal pH and bilirubin monitoring.
Results: According to endoscopic findings, 95 patients (43 men, 50±10 years of age) were divided into two groups: the reflux esophagitis (RE) group (n=51) and the NERD group (n=44). Three DGER parameters, the percentage of time with absorbance greater than 0.14, the total number of reflux episodes and the number of bile reflux episodes lasting longer than 5 min, were evaluated in the study. For the RE group, the values of the DGER parameters (19.05%±223-44%, 30.56±34-04 and 5.90±6.37, respectively) were significantly higher than those of the NERD group (7.26%±11.08%, 15.68±20.92 and 2.59±3.57, respectively, P<0.05 for all) but no significant difference was found in acid reflux. Of NERD patients, 18.5% were diagnosed with simple DGER. The positive diagnosis rate of NERD could be significantly elevated from 65.9% to 84.1% (P<0.05), if bilirubin monitoring was employed in diagnosis.
Conclusions: DGER may occur independently but plays an important role in the development of RE and GERD symptoms. Simultaneous 24 h esophageal pH and bilirubin monitoring is superior to simple pH monitoring in helping identify patients at risk for NERD.
ISSN: 0835-7900
EISSN: 1916-7237
DOI: 10.1155/2006/498142
Rights: Copyright © 2006 Hindawi Publishing Corporation. This is an open access article distributed under the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
©2006 Pulsus Group Inc. All rights reserved.
The following publication Xu, X. -., Li, Z. -., Zou, D. -., Xu, G. -., Ye, P., Sun, Z. -., . . . Zeng, Y. -. (2006). Role of duodenogastroesophageal reflux in the pathogenesis of esophageal mucosal injury and gastroesophageal reflux symptoms. Canadian Journal of Gastroenterology, 20(2), 91-94 is available at
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