MATERIALS AND METHODS Patients and methods A total of 99 patients (41 male and 58 female) certainly with DGR were undergoing esophagogastroduodenoscopy (EGD) from September 2011 to March 2012 at Shanghai Tenth People��s Hospital, Tongji University. The diagnosis of DGR was based on the combination of the following arguments: a long history of gastric symptoms poorly responsive to prokinetics, mucosa-protective medicines, H2-blockers and/or proton-pump inhibitors (PPI), gastroesophageal reflux symptoms unresponsive to PPI, gastritis on upper GI endoscopy, and/or at histology, presence of a large amount of bile in the gastric cavity at > 1 endoscopic examination, pathologic at 24-h intragastric bile monitoring with the Bilitec device. The gastric juice was often lucidity or light yellow-green and/or associated mucosal change in these patients�� endoscopic images.

Before investigation, all patients were interviewed by the senior author for the presence of both upper abdominal symptoms (heartburn, regurgitation, nocturnal cough and chest pain) and dyspeptic symptoms (nausea, epigastric pain, gassy or bloating feelings, vomiting). None of the patients had diabetes mellitus, neurological disorders, vascular diseases, collagen diseases, neoplastic diseases or inflammatory bowel disease. Acute cases and patients who had previously undergone gastrectomy or esophagotomy were excluded. As a control group, 70 consecutive patients (35 male and 35 female) who needed EGD for an annual medical check-up were enrolled.

None had undergone earlier esophageal, gastric or biliary surgery; and none had earlier gastrointestinal diseases or was on medication which would influence gastric acidity or motility. After this, all patients underwent upper gastrointestinal endoscopy and found gastric juice was normal and the gastric mucosa was not damaged obviously under the macroscopic observation. The protocol of this study was approved by the ethics committee of the Shanghai Tenth People��s Hospital. Written informed consent was obtained from all participants. Endoscopic study Endoscopic examination was performed to find the evidence of DGR in all patients using fiber optic gastroduodenoscopy (The GIF-H260 and Q260 endoscopes, Olympus Medical Systems Co., Tokyo, Japan). To ensure the most accurate results possibly, Cilengitide every patient was not taken any food or drink for 8-10 h before examination to allow a valid examination of the upper gastric intestinal (GI) tract and to lower the risk of vomiting. The doctor explained the test to everyone, including the possibility of biopsy and risks such as the need to remove polyps or other surgical procedures and asked to sign a consent form agreeing to the procedure.