In the previous researches, DGR occurred in 30% to 40% of adult patients presenting with acid reflux esophagitis or gastroesophageal reflux disease[12,13]. It is common even in asymptomatic subjects, especially in Pazopanib side effects gastric and duodenal ulcer patients, gastric surgery, gallstone patients, patients undergoing gallbladder operations and cases of chronic pulmonary disease. DGR is a physiologic event, but also that the pathologic presence of duodenal juice in the foregut lumen may account for the development of Barrett��s metaplasia and dysplasia[14,15], and for that of gastric polyps[16], as well. Excessive DGR has been associated with the development of antral gastritis, gastric ulcers, alkaline esophagitis, esophageal or gastric adenocarcinoma, and intestinal metaplasia of the gastric mucosa[17-20].

Gastric mucosal damage induces mast cell degranulation and a release of vasoactive mediators, such as histamine, leading to vascular congestion and lamina propria edema[21]. Accurate detection of DGR has been a major problem for many years. The exact pathogenic features of bile reflux in unoperated stomach as well as its contributions to gastric mucosal lesions in chronic gastritis are still remaining unrevealed[22]. The clinical diagnosis of excessive DGR is usually based on endoscopic observation of bile reflux found in the stomach, antral gastritis or ulceration, or the histologic documentation of foveolar hyperplasia, vascular congestion, lamina propria edema or chemical gastritis[23-25].

The various techniques employed to detect DGR are endoscopy gastroduodenal intubation and direct sampling, gastric pH monitoring, ambulatory gastric bilirubin monitoring and hepatobiliary scintigraphy. Among them, the use of the intubation technique is considered non-physiologic since it is invasive AV-951 and thereby may spuriously provoke reflux. Gastric pH monitoring is cumbersome, entails the use of sophisticated instruments and is uncomfortable for the patients. Scintigraphic documentation of DGR is technically easy, simple and physiologic as it is noninvasive[3]. Bilitec method reliably identified the presence of bilirubin and it has made feasible to quantitatively detect duodenogastroesophageal reflux of bile[26]. Just et al[27] showed that there was no correlation between an alkaline pH and the presence of bilirubin. Due to methodological discrepancies, research into the significance of duodenogastric reflux in the diagnosis of DGR has yielded varying results. Combined with past researches and practice, we think the diagnosis of DGR is still based on the systematic analysis of endoscopy, gastric fluid samples obtained by intubation and hepatobiliary scintigraphy, a more physiological, non-invasive method.