Limits...
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

Correlation of layer and secretion volume under placebo and PPI therapy. GERD and HS data are depicted as triangles and circles, respectively; placebo volumes (black), PPI volumes (grey). The offset in the correlation indicates that layer formation started when approximately 50 ml secretion was present in the stomach. For placebo, the regression coefficient was R2 = 0.7 with regression slope and offset of 1.04 ± 0.04 and -52 ± 7 ml, respectively. On pantoprazole therapy, the regression coefficient was reduced to R2 = 0.3 with regression slope and offset of 0.56 ± 0.06 and offset -18 ± 5, respectively
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

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

Fig6: Correlation of layer and secretion volume under placebo and PPI therapy. GERD and HS data are depicted as triangles and circles, respectively; placebo volumes (black), PPI volumes (grey). The offset in the correlation indicates that layer formation started when approximately 50 ml secretion was present in the stomach. For placebo, the regression coefficient was R2 = 0.7 with regression slope and offset of 1.04 ± 0.04 and -52 ± 7 ml, respectively. On pantoprazole therapy, the regression coefficient was reduced to R2 = 0.3 with regression slope and offset of 0.56 ± 0.06 and offset -18 ± 5, respectively

Mentions: Layer thickness at 60 min after the meal decreased on PPI treatment by 19 ± 1.6 mm for HS and 27 ± 1.7 mm for GERD (p < 0.0001 in both groups), with no difference between the study groups (both p ≥ 0.4). On placebo there was a positive linear correlation between layer volume and secretion volume (Fig. 6). The secretion layer (defined as ≥70 % secretions) appeared when approximately 50 ml of secretion accumulated in the stomach and then increased in direct proportion with overall secretion volume.Fig. 6


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)

Correlation of layer and secretion volume under placebo and PPI therapy. GERD and HS data are depicted as triangles and circles, respectively; placebo volumes (black), PPI volumes (grey). The offset in the correlation indicates that layer formation started when approximately 50 ml secretion was present in the stomach. For placebo, the regression coefficient was R2 = 0.7 with regression slope and offset of 1.04 ± 0.04 and -52 ± 7 ml, respectively. On pantoprazole therapy, the regression coefficient was reduced to R2 = 0.3 with regression slope and offset of 0.56 ± 0.06 and offset -18 ± 5, respectively
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

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

Fig6: Correlation of layer and secretion volume under placebo and PPI therapy. GERD and HS data are depicted as triangles and circles, respectively; placebo volumes (black), PPI volumes (grey). The offset in the correlation indicates that layer formation started when approximately 50 ml secretion was present in the stomach. For placebo, the regression coefficient was R2 = 0.7 with regression slope and offset of 1.04 ± 0.04 and -52 ± 7 ml, respectively. On pantoprazole therapy, the regression coefficient was reduced to R2 = 0.3 with regression slope and offset of 0.56 ± 0.06 and offset -18 ± 5, respectively
Mentions: Layer thickness at 60 min after the meal decreased on PPI treatment by 19 ± 1.6 mm for HS and 27 ± 1.7 mm for GERD (p < 0.0001 in both groups), with no difference between the study groups (both p ≥ 0.4). On placebo there was a positive linear correlation between layer volume and secretion volume (Fig. 6). The secretion layer (defined as ≥70 % secretions) appeared when approximately 50 ml of secretion accumulated in the stomach and then increased in direct proportion with overall secretion volume.Fig. 6

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