Abstract：OBJECTIVE: To explore the incidence of acid and bile reflux in children with gastroesophageal reflux disease (GERD) and to study the roles of bile and gastrin in the pathogenesis of childhood GERD. METHODS: Forty-two cases of GERD were divided into two groups according to endoscopic findings: reflux esophagitis (RE) and non-erosive reflux disease (NERD). The patients underwent 24-hr ambulatory esophageal pH and bilirubin monitoring. The serum concentration of gastrin was detected by radioimmunoassay. Thirteen children without gastroesophageal reflux symptoms, digestive tract disease and severe systemic organic disease served as the Control group. RESULTS: Of the 42 cases of GERD, 24 cases were confirmed with RE, with esophageal mucosal lesions, and 18 were NERD without esophageal mucosal lesions by endoscopy. Both acid and bile reflux parameters, including the percentage of total time with pH<4 and bilirubin absorbance ≥0.14, the total number of reflux episodes and the number of bile reflux episodes lasting longer than 5 minutes, were significantly higher in the GERD patients than those in the Control group (P<0.05). The time of esophageal acid exposure (pH<4) and the percentage of total time with bilirubin absorbance ≥0.14 increased significantly in the RE group compared with in the NERD group (P<0.05). Sixteen RE patients had a mixed reflux of bile and acid (66.7%) but only 6 NERD patients (33.3%) had (P<0.01). The serum concentration of gastrin in the RE group (125.12±45.06 pg/mL) and the NERD group (98.22±27.92 pg/mL) was significantly higher than that of the Control group (74.22±20.34 pg/mL) (P<0.01, P<0.05 respectively). A significant difference was noted in the serum concentration of gastrin between the RE and the NERD groups (P< 0.05). CONCLUSIONS: Mixed reflux of bile and acid are common in children with GERD. Bile reflux may play a role in the development of GERD. Gastrin parasecretion may participate in the development of GERD. Gastrin and bile reflux may have synergistic effects on the development of childhood GERD.
WEI Ju-Rong,JIN Run-Ming,ZHOU Shao-Ming et al. Roles of bile and gastrin in the pathogenesis of childhood gastroesophageal reflux disease[J]. CJCP, 2006, 8(4): 287-290.
