{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,18]],"date-time":"2026-10-18T05:24:21Z","timestamp":1792301061612,"version":"4.4.0"},"reference-count":41,"publisher":"BMJ","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Gut"],"accepted":{"date-parts":[[1998,12,17]]},"published-print":{"date-parts":[[1999,5,1]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND<\/jats:title>\n                    <jats:p>Bile acid toxicity has been shown in the gastric, colonic, and hepatic tissues; the effect on oesophageal mucosa is less well known.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>AIMS<\/jats:title>\n                    <jats:p>To determine the spectrum of bile acids refluxing in patients with gastro-oesophageal reflux disease and its relation to oesophageal pH using a new technique of combined oesophageal aspiration and pH monitoring.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec sec-type=\"methods\">\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>Ten asymptomatic subjects and 30 patients with symptoms of gastro-oesophageal reflux disease (minimal mucosal injury, erosive oesophagitis (grade 2 or 3 Savary-Miller), Barrett\u2019s oesophagus\/stricture; n=10 in each group) underwent 15 hour continuous oesophageal aspiration with simultaneous pH monitoring. Bile acid assay of the oesophageal samples was performed using modified high performance liquid chromatography.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>\n                      The peak bile acid concentration and DeMeester acid scores were significantly higher in the patients with oesophagitis (median bile acid concentration 124 \u03bcmol\/l; acid score 20.2) and Barrett\u2019s oesophagus\/stricture (181 \u03bcmol\/l; 43.3) than patients with minimal injury (14 \u03bcmol\/l; 12.5) or controls (0 \u03bcmol\/l; 11.1). The predominant bile acids detected were cholic, taurocholic, and glycocholic acids but there was a significantly greater proportion of secondary bile acids, deoxycholic and taurodeoxycholic acids, in patients with erosive oesophagitis and Barrett\u2019s oesophagus\/stricture. Although bile acid reflux episodes occurred at variable pH, a temporal relation existed between reflux of taurine conjugates and oesophageal acid exposure (\n                      <jats:italic>r<\/jats:italic>\n                      =0.58, p=0.009).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSION<\/jats:title>\n                    <jats:p>Toxic secondary bile acid fractions have been detected in patients with extensive mucosal damage. Mixed reflux is more harmful than acid reflux alone with possible toxic synergism existing between the taurine conjugates and acid.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/gut.44.5.598","type":"journal-article","created":{"date-parts":[[2010,6,30]],"date-time":"2010-06-30T12:46:12Z","timestamp":1277901972000},"page":"598-602","source":"Crossref","is-referenced-by-count":328,"title":["Toxic bile acids in gastro-oesophageal reflux disease: influence of gastric acidity"],"prefix":"10.1136","volume":"44","author":[{"given":"D","family":"Nehra","sequence":"first","affiliation":[{"name":"aDepartments of General Surgery and Medical Biochemistry, Wrexham Maelor Hospital, Wrexham, UK, \n\nbSingleton Hospital, Swansea, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"P","family":"Howell","sequence":"additional","affiliation":[{"name":"aDepartments of General Surgery and Medical Biochemistry, Wrexham Maelor Hospital, Wrexham, UK, \n\nbSingleton Hospital, Swansea, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C P","family":"Williams","sequence":"additional","affiliation":[{"name":"aDepartments of General Surgery and Medical Biochemistry, Wrexham Maelor Hospital, Wrexham, UK, \n\nbSingleton Hospital, Swansea, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J K","family":"Pye","sequence":"additional","affiliation":[{"name":"aDepartments of General Surgery and Medical Biochemistry, Wrexham Maelor Hospital, Wrexham, UK, \n\nbSingleton Hospital, Swansea, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J","family":"Beynon","sequence":"additional","affiliation":[{"name":"aDepartments of General Surgery and Medical Biochemistry, Wrexham Maelor Hospital, Wrexham, UK, \n\nbSingleton Hospital, Swansea, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[1999,5,1]]},"reference":[{"key":"2025120618313751000_44.5.598.1","doi-asserted-by":"crossref","first-page":"178","DOI":"10.1016\/S0016-5085(19)33593-0","article-title":"Bile damage to the gastric mucosal barrier: the influence of pH and bile acid concentration.","volume":"61","author":"Black","year":"1971","journal-title":"Gastroenterology"},{"key":"2025120618313751000_44.5.598.2","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9610(78)90008-9"},{"key":"2025120618313751000_44.5.598.3","doi-asserted-by":"publisher","DOI":"10.1002\/bjs.1800750612"},{"key":"2025120618313751000_44.5.598.4","first-page":"3761","article-title":"Nature of tissue bound lithocholic acid and its implication in the role of bile acids in carcinogenesis.","volume":"41","author":"Turjman","year":"1981","journal-title":"Cancer Res"},{"key":"2025120618313751000_44.5.598.5","doi-asserted-by":"crossref","first-page":"861","DOI":"10.1042\/bst0120861","article-title":"The faecal ratio of lithocholic to deoxycholic acid may be important aetiological factor in colorectal cancer.","volume":"12","author":"Owen","year":"1984","journal-title":"Biochem Soc Trans"},{"key":"2025120618313751000_44.5.598.6","doi-asserted-by":"crossref","first-page":"328","DOI":"10.1016\/0005-2760(67)90108-7","article-title":"Inhibition of hepatic sterol oxidation by cholanic (bile) acids and their conjugates.","volume":"137","author":"Dean","year":"1967","journal-title":"Biochim Biophys Acta"},{"key":"2025120618313751000_44.5.598.7","doi-asserted-by":"publisher","DOI":"10.1002\/hep.1840040416"},{"key":"2025120618313751000_44.5.598.8","doi-asserted-by":"publisher","DOI":"10.1136\/gut.34.1.11"},{"key":"2025120618313751000_44.5.598.9","doi-asserted-by":"publisher","DOI":"10.1007\/BF01537239"},{"key":"2025120618313751000_44.5.598.10","doi-asserted-by":"crossref","first-page":"131","DOI":"10.1093\/dote\/7.2.131","article-title":"Fiberoptic measurement of \u201calkaline\u201d gastro-esophageal reflux: technical aspects and clinical indications.","volume":"7","author":"Bechi","year":"1994","journal-title":"Dis Eso"},{"key":"2025120618313751000_44.5.598.11","doi-asserted-by":"publisher","DOI":"10.1088\/0967-3334\/15\/1\/005"},{"key":"2025120618313751000_44.5.598.12","first-page":"1050","article-title":"Bilitec 2000 ambulatory duodenogastric reflux monitoring system. 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