Endoscopic evidence of bile reflux may predict the development of Barrett's esophagus

Background: Although bile reflux plays an important role in the development of Barrett’s esophagus (BE), the relationship between the endoscopic findings of bile reflux and BE is still unclear. In this study, we evaluated whether endoscopic evidence of bile reflux is associated with the presence of BE.
Methods: A retrospective analysis of a prospectively maintained database comprised of consecutive patients who underwent screening gastroscopy was performed. Endoscopic evidence of bile reflux was defined as the presence of bile-stained fluid in the gastric fundus. We performed multivariate analyses to determine factors that differed significantly between patients with and without BE.
Results: Among 3,183 patients, 715 (23%) had BE, and endoscopic evidence of bile reflux was found in 767 (24%). On multivariate analysis, endoscopic evidence of bile reflux was the strongest independent factor associated with the presence of BE (odds ratio (OR) 7.78, 95% confidence interval (CI) 6.33-9.56) compared with the presence of sliding hiatus hernia (OR 3.53, 95%CI 2.79-4.48) or male sex (OR 1.73, 95%CI 1.35-2.21).
Conclusion: In this study, endoscopic evidence of bile reflux was independently associated with the presence of BE. Bile reflux may therefore predict which patients with gastroesophageal reflux disease are at risk of developing BE and therefore which patients would benefit from gastroscopy surveillance.