Diagnosis of incipient reflux esophagitis: a new test.

Sensitivity and reliability of a new esophageal perfusion test was evaluated and compared with those of the standard hydrochloric acid (N/10 HCl) perfusion test. Sixty-four patients including 43 with biopsy-proven reflux esophagitis (group A) and 21 with negative esophageal biopsy and equivocal symptoms (Group B) had esophageal perfusion with N/10 HCl and with taurine bile salt conjugates in N/10 HCl (T-N/10 HCl) in a double-blind, randomized fashion. In group A, T-N/10 HCl perfusion led to 100% positive results as opposed to 70% with N/10 HCl perfusion. Moreover, response times were significantly shorter (9 +/- 4 min) and washout times longer (18 +/- 4 min) with T-N/10 HCl than with N/10 HCl perfusion (18 +/- 5 min, P less than .001; and 10 +/- 3 min, P less than .001, respectively). All (100%) group B patients had negative N/10 HCl perfusion tests, whereas eight (40%) had positive T-N/10 HCl tests. All patients with positive T-N/10 HCl tests improved with administration of antacids and bile salt binders, whereas none with negative T-N/10 HCl tests improved with such therapy. Accordingly, T-N/10 HCl perfusion was more sensitive than N/10 HCl perfusion for detection of reflux esophagitis. Since all biopsy-negative patients who responded to treatment normally reserved for reflux esophagitis had a positive T-N/10 HCl test, it is possible that this test was able to detect early incipient esophagitis, before histologic changes became apparent at biopsy.

Effect of perfusion of bile salts solutions into the oesophagus of hiatal hernia patients and controls.

Tests of the response to perfusion of the oesophagus were made in 54 patients divided into three groups. Group I consisted of patients with symptomatic hiatal hernia, group II hiatal hernia patients with peptic stricture, and group III normal individuals. Each individual oesophagus was perfused at a rate of 45-65 drops per minute over 25 minutes with six solutions: normal saline, N/10 HCl, taurine conjugates of bile salts in normal saline, taurine conjugates of bile salts in N/10 HCl, glycine conjugates of bile salts in normal saline, and taurine and glycine conjugates in a ratio of 1 to 2 in normal saline. It was found that acidified taurine solutions were more irritating than acid alone. With a 2mM/l solution of taurine in acid, symptoms are produced even in controls. With a 1 mM/l solution of the same conjugates, the majority of normal people feel slight heartburn or nothing, and therefore perfusion into the oesophagus of such a solution could be used as a test for oesophagitis.