The Role of Bile and Acid in the Production of Esophagitis and the Motor Defect of Esophagitis

Abstract

Esophagitis is frequently associated with the reflux of gastric contents into the esophagus, but the incidence and severity of esophagitis do not always correlate well with the history of reflux or the roentgenographic findings. Duodenal bile reflux into the antrum of the stomach has been implicated as a cause of gastritis. To study the effects of bile and acid upon the esophagus, bile, bile salts, or hydrochloric acid in single solution or in combination was dripped into the esophagus in dogs. Bile salts, particularly taurocholate and glycocholate, combined with normal hydrochloric acid produced Stage III esophagitis. The motor defect of Stage III esophagitis was studied, and it was found that esophagitis produced severely disordered motor activity in the body of the esophagus, reduced the tone of the gastroesophageal junction, and decreased the ability of the gastroesophageal junction to relax in response to deglutition. The manometric changes seen correspond with those occurring in patients with a hiatus hernia and reflux.