Biliary reflux after bariatric surgery and after gastroesophageal surgery for gastroesophageal reflux disease

Elisa Marabotto, Amir Mari, Francesco Calabrese, Andrea Pasta, Shirin Djahandideh Sheijani, Edoardo Giovanni Giannini, Vincenzo Savarino, Edoardo Savarino

Research output: Contribution to journalReview articlepeer-review


Biliary reflux refers to the ascent of duodenal fluid, biliary and pancreatic secretions into the stomach and esophagus. It is a primitive phenomenon or it can be secondary to gastric or biliary surgery. In particular, biliary reflux seems common after bariatric surgeries with, however, unknown incidence. Current data show that the prevalence of biliary reflux was higher after minigastric bypass as compared to the other bariatric surgeries. Nevertheless, biliary reflux resulted to be a relevant risk factor for the development of reflux-related complications, such as erosive esophagitis and Barrett esophagus, and its persistence over time seems to be an independent risk factor for gastric cancer. Its evaluation is challenging, and several methods have been proposed to date. Hepatobiliary iminodiacetic acid (HIDA) assessment is a non-invasive technique which showed a good correlation with gastric bile acids in several clinical investigations. Impedance-pH monitoring has been shown to correctly identify non-acidic reflux, but it is not considered a valid tool to diagnose the occurrence of bile reflux episodes in the esophagus since its inability to distinguish bile from other non-acidic components of the refluxate like food. Fibreoptic spectrophotometric probe (Bilitec) was proposed to quantify bile reflux in an ambulatory setting and over a prolonged period, using bilirubin as a marker for the presence of duodenal contents. Only few studies have addressed the impact of anti-reflux surgeries on treating biliary reflux, although these procedures appear to be effective to improve clinical and objective outcomes of this complication.

Original languageEnglish
Article number2
JournalDigestive Medicine Research
StatePublished - 30 Mar 2024

Bibliographical note

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  • Bilitec
  • Impedance-pH
  • duodenal re
  • gastroesophageal reflux disease (GERD)
  • reflux


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