Background: Reflux of duodeno-gastric juice into the oesophagus appears to
be involved in the pathogenesis of both reflux oesophagitis and oesophageal
adenocarcinoma. Although proton pump inhibitors have been shown to decreas
e acid reflux and heal oesophagitis, their effect on biliary reflux and mot
ility is less clear.
Aim: To investigate whether pantoprazole also reduces bile reflux and wheth
er this is paralleled by a change in oesophageal motility.
Methods: Combined 24-h measurements of intraoesophageal bilirubin concentra
tion, pH and pressure were performed in 18 symptomatic patients with endosc
opically proven reflux oesophagitis before and on day 28 of treatment with
pantoprazole, 40 mg/day, under standardized conditions. A reflux symptom sc
ore was determined initially and every 2 weeks thereafter. After 56 days on
medication, a control endoscopy was performed.
Results: The symptom score and the acid and bile reflux improved significan
tly, whereas the motility parameters did not change during the study period
. Helicobacter pylori-positive patients had a significantly higher bile ref
lux time (32.1 +/- 4.3%) than H. pylori-negative patients (16.3 +/- 3.1%) (
P = 0.009). The endoscopic healing rate was 89%. The cough symptoms disappe
ared in three of four patients.
Conclusions: The proton pump inhibitor pantoprazole decreases both acid and
bile reflux. The decrease of bile reflux cannot be explained by increased
oesophageal clearance as oesophageal motility did not improve with therapy.
Interestingly, H. pylori infection of the stomach was associated with high
er levels of oesophageal bile reflux.