The acid pocket: a target for treatment in reflux disease?

Kahrilas, P.J., McColl, K., Fox, M., O'Rourke, L., Sifrim, D., Smout, A.J.P.M. and Boeckxstaens, G. (2013) The acid pocket: a target for treatment in reflux disease? American Journal of Gastroenterology, 108(7), pp. 1058-1064. (doi: 10.1038/ajg.2013.132)

Abstract

The nadir esophageal pH of reflux observed during pH monitoring in the postprandial period is often more acidic than the concomitant intragastric pH. This paradox prompted the discovery of the “acid pocket”, an area of unbuffered gastric acid that accumulates in the proximal stomach after meals and serves as the reservoir for acid reflux in healthy individuals and gastroesophageal reflux disease (GERD) patients. However, there are differentiating features between these populations in the size and position of the acid pocket, with GERD patients predisposed to upward migration of the proximal margin onto the esophageal mucosa, particularly when supine. This upward migration of acid, sometimes referred to as an “acid film”, likely contributes to mucosal pathology in the region of the squamocolumnar junction. Furthermore, movement of the acid pocket itself to a supradiaphragmatic location with hiatus hernia increases the propensity for acid reflux by all conventional mechanisms. Consequently, the acid pocket is an attractive target for GERD therapy. It may be targeted in a global way with proton pump inhibitors that attenuate acid pocket development, or with alginate/antacid combinations that colocalize with the acid pocket and displace it distally, thereby demonstrating the potential for selective targeting of the acid pocket in GERD.

• Item Type: Articles
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: McColl, Professor Kenneth
• Authors: Kahrilas, P.J., McColl, K., Fox, M., O'Rourke, L., Sifrim, D., Smout, A.J.P.M., and Boeckxstaens, G.
• College/School: College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health
• Journal Name: American Journal of Gastroenterology
• Publisher: Nature Publishing Group
• ISSN: 0002-9270
• ISSN (Online): 1572-0241
• Copyright Holders: Copyright © 2013 American College of Gastroenterology
• First Published: First published in American Journal of Gastroenterology 108(7):1058-1064
• Publisher Policy: Reproduced under a Creative Commons License