A study was conducted to determine bile acids in human saliva with the help of a sensitive ultraperformance liquid chromatography tandem mass spectrometry analysis method in order to ascertain the quantitative differences in refractory gastroesophageal reflux disease (GERD) patients in comparison with GERD patients controlled with proton pump inhibitors (PPI) and healthy volunteers.

Investigators analyzed human saliva samples from 2 separate studies. The first one was a meal-controlled pilot study wherein premeal and postmeal saliva samples were assessed from 20 healthy individuals and 20 patients with GERD symptoms controlled with PPIs. In a second exploratory study, saliva samples were obtained from 34 patients with persisting GERD symptoms in spite of receiving PPI therapy (refractory GERD), 30 healthy subjects, and 30 PPI-controlled GERD patients at ≥4 hours following a meal.

Findings of the study

• In the meal-controlled pilot analysis, healthy individuals and patients with PPI-controlled GERD were found to have total saliva bile acid increase for the first hour following a meal and it came back to baseline levels 4 hours later. There appeared to be no difference in bile acid levels between the two groups.
• In the exploratory study, saliva obtained from patients with refractory GERD was noted to have statistically significantly higher levels of total bile acid concentration vs. healthy individuals and patients with PPI-controlled GERD.

To conclude, it is possible to detect and measure bile acids in human saliva using a sensitive ultraperformance liquid chromatography tandem mass spectrometry assay.

Levels above threshold could point to underlying disease.

This method could have a role in evaluating biliary reflux as an underlying factor in refractory GERD.

Source: Perez N, Chambert K, Ribadeneira M, et al. Differential Bile Acid Detection in Refractory GERD Patient Saliva Using a Simple and Sensitive Liquid Chromatography Tandem Mass Spectrometry Approach. J Clin Gastroenterol. 2022 Mar 1;56(3):218-223.