24-hour multi-pH recording of the postprandial acid pocket and the nocturnal acid distribution at the esophagogastric junction in healthy volunteers.
EGJ
Gastroesophageal reflux disease
acid pocket
lower esophageal sphincter
Journal
Neurogastroenterology and motility
ISSN: 1365-2982
Titre abrégé: Neurogastroenterol Motil
Pays: England
ID NLM: 9432572
Informations de publication
Date de publication:
11 2019
11 2019
Historique:
received:
28
12
2018
revised:
12
07
2019
accepted:
23
07
2019
pubmed:
27
8
2019
medline:
22
9
2020
entrez:
27
8
2019
Statut:
ppublish
Résumé
Postprandial stationary pH monitoring studies have identified the acid pocket. To what extent a similar pool of acid is present in the fasting state or at night remains however unclear. The study was performed in 9 HV without a hiatal hernia. A pH-impedance-pressure catheter was positioned at the Z-line. First, the presence of the acid pocket was monitored under stationary conditions during 2 hours after ingestion of a standardized meal. Thereafter, the equipment was connected to an ambulatory monitoring device for 24-hour recording. Under stationary conditions, a postprandial acid pocket was present in 7 of the 9 HV, from 9 ± 7 minutes after meal onwards during 47 ± 8 minutes. During ambulatory 24-hour monitoring, postprandial acid pockets emerged significantly later, but no differences in duration or position were detected. During nighttime, an acid pool was detected with its proximal border at the level of the cardia, which at later, time points gradually moved to a more distal position. This led to a gradual decrease in nocturnal acid exposure from proximal to distal, a phenomenon that was preceded by a bust of gastric contractions. Nocturnal reflux originated from the cardiac region, and was more acidic in the early compared with late nocturnal period. The acid pocket is present in the postprandial period under both stationary and ambulatory conditions. Of interest, at night, a pool of acid can be demonstrated which is periodically shifted more distally. This pool of acid represents the reservoir from which nocturnal reflux originates.
Sections du résumé
BACKGROUND
Postprandial stationary pH monitoring studies have identified the acid pocket. To what extent a similar pool of acid is present in the fasting state or at night remains however unclear.
METHODS
The study was performed in 9 HV without a hiatal hernia. A pH-impedance-pressure catheter was positioned at the Z-line. First, the presence of the acid pocket was monitored under stationary conditions during 2 hours after ingestion of a standardized meal. Thereafter, the equipment was connected to an ambulatory monitoring device for 24-hour recording.
RESULTS
Under stationary conditions, a postprandial acid pocket was present in 7 of the 9 HV, from 9 ± 7 minutes after meal onwards during 47 ± 8 minutes. During ambulatory 24-hour monitoring, postprandial acid pockets emerged significantly later, but no differences in duration or position were detected. During nighttime, an acid pool was detected with its proximal border at the level of the cardia, which at later, time points gradually moved to a more distal position. This led to a gradual decrease in nocturnal acid exposure from proximal to distal, a phenomenon that was preceded by a bust of gastric contractions. Nocturnal reflux originated from the cardiac region, and was more acidic in the early compared with late nocturnal period.
CONCLUSION
The acid pocket is present in the postprandial period under both stationary and ambulatory conditions. Of interest, at night, a pool of acid can be demonstrated which is periodically shifted more distally. This pool of acid represents the reservoir from which nocturnal reflux originates.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
e13694Informations de copyright
© 2019 John Wiley & Sons Ltd.
Références
Fletcher J, Wirz A, Young J, Vallance R, McColl K. Unbuffered highly acidic gastric juice exists at the gastroesophageal junction after a meal. Gastroenterology. 2001;121(4):775-783.
Rohof WO, Bennink RJ, Boeckxstaens GE. Proton pump inhibitors reduce the size and acidity of the acid pocket in the stomach. Clin Gastroenterol Hepatol. 2014;12(7):1101-1107.
Beaumont H, Bennink RJ, de Jong J, Boeckxstaens GE. The position of the acid pocket as a major risk factor for acidic reflux in healthy subjects and patients with GORD. Gut. 2010;59(4):441-451.
Woodland P, Al-Zinaty M, Yazaki E, Sifrim D. In vivo evaluation of acid-induced changes in oesophageal mucosa integrity and sensitivity in non-erosive reflux disease. Gut. 2013;62(9):1256-1261.
Katzka DA, Gideon RM, Castell DO. Normal patterns of acid exposure at the gastric cardia: a functional midpoint between the esophagus and stomach. Am J Gastroenterol. 1998;93(8):1236-1242.
Vo L, Simonian HP, Doma S, Fisher RS, Parkman HP. The effect of rabeprazole on regional gastric acidity and the postprandial cardia/gastro-oesophageal junction acid layer in normal subjects: a randomized, double-blind, placebo-controlled study. Aliment Pharmacol Ther. 2005;21(11):1321-1330.
Das KM, Kong Y, Bajpai M, et al. Transformation of benign Barrett’s epithelium by repeated acid and bile exposure over 65 weeks: a novel in vitro model. Int J Cancer. 2011;128(2):274-282.
Chang F-Y, Lu C-L, Chen C-Y, et al. Stomach myoelectrical response of patients with gastroesophageal reflux disease receiving omeprazole treatment. J Gastroenterol Hepatol. 2003;18(12):1399-1406.
Adachi K, Fujishiro H, Katsube T, et al. Predominant nocturnal acid reflux in patients with Los Angeles grade C and D reflux esophagitis. J Gastroenterol Hepatol. 2001;16(11):1191-1196.
Clarke AT, Wirz AA, Seenan JP, Manning JJ, Gillen D, McColl K. Paradox of gastric cardia: it becomes more acidic following meals while the rest of stomach becomes less acidic. Gut. 2009;58(7):904-909.