Work

The Impact of Diet and Enteral Tube Type on Gastric Bile Acid Concentrations and Pulmonary Outcomes

Year: 2026

Type: article

Abstract: BACKGROUND & AIMS: Bile acid reflux has been implicated as a cause for esophagitis, pulmonary fibrosis, and other aerodigestive disorders. The goal of this study was to determine the relationship between gastric and lung bile acid concentrations and if diet was a modifiable risk factor to reduce bile acid reflux. METHODS: We prospectively recruited children with oropharyngeal dysphagia and respiratory symptoms undergoing aerodigestive testing. Gastric and, when available, lung bile acid concentrations were quantified using liquid chromatography-mass spectrometry. In a subgroup of enterally fed patients, serum 7α-hydroxy-4-cholesten-3-one (C4) levels were measured. RESULTS: In this prospective cohort of 141 participants, gastric bile acids concentrations were highest in those fed orally compared with enteral tubes (P = .008). Gastric bile acid was a strong predictor of lung bile acids in children receiving blenderized tube feeds (r = 0.57; P = .03), but not formula (r = 0.34; P = .09), or oral feeds (r = -0.02; P = .89). Low lung bile acid concentration predicted low neutrophil counts in the lung (r = 0.39; P = .003), as did use of blenderized tube feeds (oral, 5 [interquartile range (IQR), 26]; formula, 7.5 [IQR, 37.5]; blenderized, 0 [IQR, 0]; P = .008). Quartile gastric and lung bile acids were strong predictors of hospitalization rates (P < .001 for both). Serum C4 levels, a surrogate for bile acid synthesis rate, did not support evidence of excessive bile acid loss with blenderized tube feeds (blenderized, 2.3 [IQR, 11.3] vs formula, 18.1 [IQR, 34.8] ng/mL; P = .03). CONCLUSIONS: For patients at high risk for bile acid-related aerodigestive complications, tube and diet type may affect gastric bile acid concentrations, in turn impacting important clinical outcomes of hospitalization rates and airway inflammation.

Source: Clinical Gastroenterology and Hepatology

DOI: 10.1016/j.cgh.2026.03.036