Researchers have found that endoscopic evidence of bile reflux is strongly associated with the presence of Barrett's esophagus. This finding comes from a retrospective analysis of a prospectively maintained database of consecutive patients who underwent screening esophagogastroduodenoscopy. This study was published in the journal Digestive and Liver Disease by Yugo I. and colleagues.
Barrett's esophagus is a condition in which the lining of the esophagus changes, potentially increasing the risk of esophageal cancer. Although bile reflux is known to play a role in the development of Barrett's esophagus, the relationship between endoscopic evidence of bile reflux and the condition remains unclear. This study sought to evaluate whether endoscopic evidence of bile reflux is associated with the presence of Barrett's esophagus.

The researchers conducted a retrospective analysis of a database comprising consecutive patients who underwent screening esophagogastroduodenoscopy. Endoscopic evidence of bile reflux was defined as the presence of bile-stained fluid in the gastric fundus. Multivariate analysis was performed to identify predictive factors that differed significantly between patients with and without Barrett's esophagus.
The key findings of the study were:
• The study involved 4,021 patients, of whom 922 (23%) had Barrett's esophagus, and 1,000 (25%) showed endoscopic findings of bile reflux.
• Multivariate analysis revealed endoscopic evidence of bile reflux as the strongest independent factor associated with the presence of Barrett's esophagus (odds ratio [OR] 5.65, 95% confidence interval [CI] 4.71–6.76).
• The analysis also found that hiatal hernia (OR 3.30, 95% CI 2.70–4.04) and male gender (OR 1.54, 95% CI 1.24–1.91) were significantly associated with the presence of Barrett's esophagus.
The study's findings suggest that endoscopic evidence of bile reflux may serve as a strong predictor for Barrett's esophagus. This could help identify patients at future risk of developing the condition and who might benefit from increased endoscopic surveillance.
The research provides compelling evidence that endoscopic bile reflux is an independent factor associated with Barrett's esophagus. This finding emphasizes the importance of monitoring bile reflux during endoscopy to identify patients who may be at increased risk of Barrett's esophagus.
Reference:
Iwaya, Y., Goda, K., Kako, S., Hattori, H., Miyazawa, T., Hara, D., Hashigami, K., Hirayama, A., Okamura, T., Nagaya, T., & Umemura, T. (2024). Association between endoscopic evidence of bile reflux and Barrett’s esophagus: A large-scale case-control study. Digestive and Liver Disease: Official Journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver, 56(4), 622–627. https://doi.org/10.1016/j.dld.2023.11.042