Postprandial Stomach Contents Have Multiple Acid Layers

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Abstract

Goals

The purpose of this study was to evaluate patterns in gastric pH both fasting and postprandially in different body positions.

Study

Ten healthy volunteers were studied. A pH probe was positioned with an electrode 15 cm below the lower esophageal sphincter proximal border then withdrawn 1 cm every 30 seconds to 5 cm above the lower esophageal sphincter. Volunteers were tested on 2 occasions. Initially, they were studied in a semirecumbent position (45 degrees), with the first pull-through after 6 hour fasting. After a meal, a pull-through was repeated 4 consecutive times (approximately 15, 30, 45, and 60 min). On a subsequent day, the positions were changed with each pull-through: upright, supine, right decubitus, and left decubitus. The order of these positions was randomly selected.

Results

The pH step-up is defined as a change in pH from a gastric to an esophageal pH (<4→>4). No significant difference was found between location of the pH step-up in the fasting and postprandial pull-throughs. An area of lower pH was consistently found within 2 cm distal to the step-up area. Distal to the area of higher gastric pH (median pH at 5), a second acid layer was found. This pattern persisted through the 4 postprandial pull-throughs, irrespective of body position.

Conclusions

The pH step-up was persistent in the fasting period and for 1 hour postprandially, but did not migrate proximally. Gastric buffering from a meal creates a nonuniform environment with at least 2 acid layers. This pattern is present irrespective of body position. The lack of homogeneity of stomach content postprandially helps to explain the observation of occasional persistent acid gastroesophageal reflux after a meal.

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