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Volume, distribution and acidity of gastric secretion on and off proton pump inhibitor treatment: a randomized double-blind controlled study in patients with gastro-esophageal reflux disease (GERD) and healthy subjects.

Steingoetter A, Sauter M, Curcic J, Liu D, Menne D, Fried M, Fox M, Schwizer W - BMC Gastroenterol (2015)

Bottom Line: MRI can visualize and quantify the volume and distribution dynamics of gastric secretions that form a layer in the proximal stomach after ingestion of a liquid meal.High dose PPI reduced secretion volume by about 50% and reduced contact time between secretion and EGJ towards normal levels.NCT01212614.

View Article: PubMed Central - PubMed

Affiliation: Division of Gastroenterology and Hepatology, University Hospital Zurich, Raemistrasse 100, CH-8091, Zurich, Switzerland. steingoetter@biomed.ee.ethz.ch.

ABSTRACT

Background: Postprandial accumulation of gastric secretions in the proximal stomach above the meal adjacent to the esophagogastric junction (EGJ), referred to as the 'acid pocket', has been proposed as a pathophysiological factor in gastro-esophageal reflux disease (GERD) and as a target for GERD treatment. This study assessed the effect of proton pump inhibitor (PPI) therapy on the volume, distribution and acidity of gastric secretions in GERD and healthy subjects (HS).

Methods: A randomized, double blind, cross-over study in 12 HS and 12 GERD patients pre-treated with 40 mg pantoprazole (PPI) or placebo b.i.d. was performed. Postprandial secretion volume (SV), formation of a secretion layer and contact between the layer and the EGJ were quantified by Magnetic Resonance Imaging (MRI). Multi-channel pH-monitoring assessed intragastric pH.

Results: A distinct layer of undiluted acid secretion was present on top of gastric contents in almost all participants on and off high-dose acid suppression. PPI reduced SV (193 ml to 100 ml, in HS, 227 ml to 94 ml in GERD; p < 0.01) and thickness of the acid layer (26 mm to 7 mm, 36 mm to 9 mm respectively, p < 0.01). No differences in secretion volume or layer thickness were observed between groups; however, off treatment, contact time between the secretion layer and EGJ was 2.6 times longer in GERD compared to HS (p = 0.012). This was not the case on PPI.

Conclusions: MRI can visualize and quantify the volume and distribution dynamics of gastric secretions that form a layer in the proximal stomach after ingestion of a liquid meal. The secretion volume and the secretion layer on top of gastric contents is similar in GERD patients and HS; however contact between the layer of undiluted secretion and the EGJ is prolonged in patients. High dose PPI reduced secretion volume by about 50% and reduced contact time between secretion and EGJ towards normal levels.

Trial registration: NCT01212614.

No MeSH data available.


Related in: MedlinePlus

Grouped meal and secretion volume curves. Meal Volume (MV) and Secretion Volume (SV) dynamics over 120 min for GERD patients and Healthy Subjects (HS), under placebo (black dots/lines) and PPI (grey triangles/lines). The approximately linear emptying pattern of the test meal is typical for a high calorie, viscous liquid meal
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Fig4: Grouped meal and secretion volume curves. Meal Volume (MV) and Secretion Volume (SV) dynamics over 120 min for GERD patients and Healthy Subjects (HS), under placebo (black dots/lines) and PPI (grey triangles/lines). The approximately linear emptying pattern of the test meal is typical for a high calorie, viscous liquid meal

Mentions: Overall maxSV was approximately 200 ml in both groups under placebo (Table 1) with no difference between groups. PPI treatment reduced maxSV by 93 ± 20 ml in HS and 134 ± 20 ml in GERD patients, respectively. No difference was observed between study groups in either study arm, all p ≥ 0.2. Individual MV and SV curves presented by study group and treatment are plotted in Fig. 4. Meal emptying, as assessed by t50, was similar in both study groups (HS vs. GERD) and was not significantly altered by treatment (placebo vs. PPI), all p > 0.2.Fig. 4


Volume, distribution and acidity of gastric secretion on and off proton pump inhibitor treatment: a randomized double-blind controlled study in patients with gastro-esophageal reflux disease (GERD) and healthy subjects.

Steingoetter A, Sauter M, Curcic J, Liu D, Menne D, Fried M, Fox M, Schwizer W - BMC Gastroenterol (2015)

Grouped meal and secretion volume curves. Meal Volume (MV) and Secretion Volume (SV) dynamics over 120 min for GERD patients and Healthy Subjects (HS), under placebo (black dots/lines) and PPI (grey triangles/lines). The approximately linear emptying pattern of the test meal is typical for a high calorie, viscous liquid meal
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4557316&req=5

Fig4: Grouped meal and secretion volume curves. Meal Volume (MV) and Secretion Volume (SV) dynamics over 120 min for GERD patients and Healthy Subjects (HS), under placebo (black dots/lines) and PPI (grey triangles/lines). The approximately linear emptying pattern of the test meal is typical for a high calorie, viscous liquid meal
Mentions: Overall maxSV was approximately 200 ml in both groups under placebo (Table 1) with no difference between groups. PPI treatment reduced maxSV by 93 ± 20 ml in HS and 134 ± 20 ml in GERD patients, respectively. No difference was observed between study groups in either study arm, all p ≥ 0.2. Individual MV and SV curves presented by study group and treatment are plotted in Fig. 4. Meal emptying, as assessed by t50, was similar in both study groups (HS vs. GERD) and was not significantly altered by treatment (placebo vs. PPI), all p > 0.2.Fig. 4

Bottom Line: MRI can visualize and quantify the volume and distribution dynamics of gastric secretions that form a layer in the proximal stomach after ingestion of a liquid meal.High dose PPI reduced secretion volume by about 50% and reduced contact time between secretion and EGJ towards normal levels.NCT01212614.

View Article: PubMed Central - PubMed

Affiliation: Division of Gastroenterology and Hepatology, University Hospital Zurich, Raemistrasse 100, CH-8091, Zurich, Switzerland. steingoetter@biomed.ee.ethz.ch.

ABSTRACT

Background: Postprandial accumulation of gastric secretions in the proximal stomach above the meal adjacent to the esophagogastric junction (EGJ), referred to as the 'acid pocket', has been proposed as a pathophysiological factor in gastro-esophageal reflux disease (GERD) and as a target for GERD treatment. This study assessed the effect of proton pump inhibitor (PPI) therapy on the volume, distribution and acidity of gastric secretions in GERD and healthy subjects (HS).

Methods: A randomized, double blind, cross-over study in 12 HS and 12 GERD patients pre-treated with 40 mg pantoprazole (PPI) or placebo b.i.d. was performed. Postprandial secretion volume (SV), formation of a secretion layer and contact between the layer and the EGJ were quantified by Magnetic Resonance Imaging (MRI). Multi-channel pH-monitoring assessed intragastric pH.

Results: A distinct layer of undiluted acid secretion was present on top of gastric contents in almost all participants on and off high-dose acid suppression. PPI reduced SV (193 ml to 100 ml, in HS, 227 ml to 94 ml in GERD; p < 0.01) and thickness of the acid layer (26 mm to 7 mm, 36 mm to 9 mm respectively, p < 0.01). No differences in secretion volume or layer thickness were observed between groups; however, off treatment, contact time between the secretion layer and EGJ was 2.6 times longer in GERD compared to HS (p = 0.012). This was not the case on PPI.

Conclusions: MRI can visualize and quantify the volume and distribution dynamics of gastric secretions that form a layer in the proximal stomach after ingestion of a liquid meal. The secretion volume and the secretion layer on top of gastric contents is similar in GERD patients and HS; however contact between the layer of undiluted secretion and the EGJ is prolonged in patients. High dose PPI reduced secretion volume by about 50% and reduced contact time between secretion and EGJ towards normal levels.

Trial registration: NCT01212614.

No MeSH data available.


Related in: MedlinePlus