Clarke, A., Wirz, A., Manning, J., Ballantyne, S., Alcorn, D. and McColl, K. (2008) Severe reflux disease is associated with an enlarged unbuffered proximal gastric acid pocket. Gut, 57(3), p. 292. (doi: 10.1136/gut.2006.109421)
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Publisher's URL: http://dx.doi.org/10.1136/gut.2006.109421
Abstract
Background: An unbuffered pocket of highly acidic juice is observed at the gastric cardia after a meal in healthy subjects. Aims: To compare the postprandial acid pocket in healthy subjects and patients with severe reflux disease and define its position relative to anatomical and manometric landmarks. Methods: 12 healthy subjects and 16 patients with severe reflux disease were studied. While fasted, a station pull-through was performed using a combined dual pH and manometry catheter. Position was confirmed by radiological visualisation of endoscopically placed radio-opaque clips. The pull-through study was repeated 15 min after a standardised fatty meal. Barium meal examination was performed before and following the meal. Results: A region of unbuffered acid (pH <= 2) immediately distal to the proximal gastric folds was more frequent in reflux patients (23/32 studies) than in healthy subjects (11/24) (p < 0.05). This unbuffered acid pocket was longer in the reflux patients than in the healthy subjects (median length 3 cm (range 1-15) vs 2 cm (range 1-5); p < 0.05). The acid pocket extended proximally as far as the proximal gastric folds in the patients but stopped a median of 1.1 cm distal in healthy subjects (p=0.005). In healthy subjects the acid pocket occupied the distal portion of the sphincter which opened postprandially, whereas in reflux patients it corresponded to the proximal displacement of the gastric folds-that is, hiatus hernia. Conclusion: This enlarged region of unbuffered postprandial acidic juice observed in the patients just below the gastro-oesophageal junction may contribute to the aetiology of severe reflux disease.
Item Type: | Articles |
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Status: | Published |
Refereed: | Yes |
Glasgow Author(s) Enlighten ID: | Alcorn, Dr Des and McColl, Professor Kenneth |
Authors: | Clarke, A., Wirz, A., Manning, J., Ballantyne, S., Alcorn, D., and McColl, K. |
College/School: | College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health College of Medical Veterinary and Life Sciences |
Journal Name: | Gut |
ISSN: | 0017-5749 |
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