Duodenogastro-oesophageal reflux

The role of duodenogastro-oesophageal reflux (DGOR), once erroneously termed ‘bile reflux’, in causing oesophageal mucosal damage has been an area of interest in both animal and human studies. However, due to the lack of appropriate techniques for accurately measuring DGOR, extrapolation of findings from animal studies to humans was difficult to make. The recent advent of the Bilitec system, an ambulatory bilirubin monitoring device, is increasing our knowledge of the specific role of DGOR in oesophageal diseases. Studies suggest that the DGOR without acid reflux may result in symptoms but unless acid reflux is present simultaneously, it does not cause oesophagitis. Therefore, our therapies should aim at reducing both DGOR and acid reflux. Studies show that this may be accomplished by anti-reflux surgery or the use of proton pump inhibitors, which, by reducing gastric volume, decrease the damaging potential of both acid and DGOR.