Several basic researches have indicated that there is a significant relationship between bile reflux and the pathogenesis of Barrett’s esophagus (BE). However, only few clinical studies have been reported regarding the endoscopic finding of bile reflux and Barrett’s esophagus. Our objective is to evaluate whether the endoscopic evidence of bile reflux is an independent factor associated with the presence of BE. Methods We conducted a retrospective analysis of a prospectively maintained database comprised of consecutive Japanese patients who underwent screening gastroscopy. Endoscopic findings of BE, reflux esophagitis, atrophic gastritis and sliding hernia were recorded. Evaluation of a BE was based on the Prague criteria. Endoscopic evidence of bile reflux was defined as the presence of yellow or green juice observed by white light image or red juice by narrow band image (NBI) in the gastric fundus. Univariate and multivariate analyses were performed to identify factors that differed significantly between patients with or without BE. Results A total of 454 patients were enrolled; 124 (27%) had BE and 126 (28%) had endoscopic evidence of bile reflux. Compared to patients without BE, patients with BE were more likely to be old, male and to have sliding hernia and endoscopic evidence of bile reflux on univariate analysis. On multivariate analysis, endoscopic evidence of bile reflux was a stronger independent factor associated with BE (odds ratio(OR) 11.3, 95% confidence interval(CI) 6.56–19.4) compared to the presence of sliding hernia (OR 3.58, 95%CI 2.14–6.0). Conclusion Endoscopic evidence of bile reflux identified by white light or NBI is a strong independent factor associated with the presence of BE, implying that this finding should be considered as an important parameter to determine the surveillance strategy for gastroesophageal reflux disease patients same as the presence of sliding hernia.

中文翻译：

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204 胆汁反流的内镜证据是与巴雷特食管存在相关的一个强有力的独立因素

多项基础研究表明，胆汁反流与巴雷特食管（BE）的发病机制密切相关。然而，关于胆汁反流和巴雷特食管的内窥镜检查发现的临床研究报道很少。我们的目标是评估胆汁反流的内镜证据是否是与 BE 存在相关的独立因素。方法 我们对一个前瞻性维护的数据库进行了回顾性分析，该数据库由接受过胃镜检查的连续日本患者组成。记录BE、反流性食管炎、萎缩性胃炎和滑疝的内镜检查结果。BE 的评估基于布拉格标准。胆汁反流的内窥镜证据被定义为在胃底中通过白光图像观察到黄色或绿色汁液或通过窄带图像（NBI）观察到红色汁液的存在。进行单变量和多变量分析以确定有或没有 BE 患者之间显着不同的因素。结果共纳入454例患者；124 人（27%）有 BE，126 人（28%）有胆汁反流的内镜证据。与没有 BE 的患者相比，有 BE 的患者更有可能是老年男性，并且单变量分析显示有滑疝和胆汁反流的内镜证据。在多变量分析中，与滑疝的存在（OR 3.58, 95%CI 2.14–6.0)。