Paradox of gastric cardia: it becomes more acidic following meals while the rest of stomach becomes less acidic

Clarke, Alan T.; Wirz, Angela A.; Seenan, John Paul; Manning, Jonathan J.; Gillen, Derek; McColl, Kenneth E.L.

doi:10.1136/gut.2008.161927

Cited by 43 publications

(46 citation statements)

References 25 publications

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“…Grigolon et al ( 22 ) timed the fi rst onset of the acid pocket using a BRAVO pH capsule 2 cm below the lower esophageal sphincter (LES) and found the median time for onset of the acid pocket was 14 min. A number of other studies corroborate this and have demonstrated that the pocket persists for up to 90 min aft er meals ( 14,17,19 ). In one study, real-time recording of fasting and postprandial luminal pH with a 12 pH electrode assembly allowed close observation of the dynamic changes to esophageal and stomach pH over time ( 14 ).…”

Section: Reviewsupporting

confidence: 55%

“…A number of other studies corroborate this and have demonstrated that the pocket persists for up to 90 min aft er meals ( 14,17,19 ). In one study, real-time recording of fasting and postprandial luminal pH with a 12 pH electrode assembly allowed close observation of the dynamic changes to esophageal and stomach pH over time ( 14 ). Recordings clearly demonstrated that the gastric cardia paradoxically became more acidic aft er a meal while the rest of the stomach became less acidic.…”

Section: Reviewsupporting

confidence: 53%

“…In this case, the acid pocket was fi rst observed 17 min aft er the meal, progressively lengthening and becoming more acidic until 44 min ( Figure 2 ). At 48 min, a highly acidic esophageal refl ux event was observed at a time when the only region of the stomach with equal acidity was the acid pocket ( 14 ).…”

Section: Reviewmentioning

confidence: 99%

“…Numerous studies have confi rmed the presence of the acid pocket ( 6,12 -20 ), investigated its precise location ( 13,15 ) and its potential role in the pathogenesis of GERD ( 13,15,19 ). It has been studied using a variety of diff erent techniques, including pH pull-through ( 12,13,15 -17 ), multiple stationary pH electrodes (14,17), single-photon emission computed tomography following injection of [ 99M Tc] pertechnetate ( 18,19 ) and, most recently, magnetic resonance imaging (MRI; Figure 1 ) ( 6,20 ).…”

Section: Reviewmentioning

confidence: 99%

See 3 more Smart Citations

The Acid Pocket: A Target for Treatment in Reflux Disease?

Kahrilas

McColl

Fox³

et al. 2013

American Journal of Gastroenterology

129

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The nadir esophageal pH of refl ux 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 refl ux in healthy individuals and gastroesophageal refl ux 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 fi lm " , 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 refl ux 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.

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Section: Reviewsupporting

confidence: 55%

Section: Reviewsupporting

confidence: 53%

Section: Reviewmentioning

confidence: 99%

Section: Reviewmentioning

confidence: 99%

See 2 more Smart Citations

The Acid Pocket: A Target for Treatment in Reflux Disease?

Kahrilas

McColl

Fox³

et al. 2013

American Journal of Gastroenterology

129

View full text Add to dashboard Cite

show abstract

“…They confirmed the maximal acidity at the cardia occurred around 60 to 70 minutes after the meal. 13 …”

Section: High-resolution Ph Studiesmentioning

confidence: 97%

The Role of the Acid Pocket in Gastroesophageal Reflux Disease

Mitchell

Derakhshan

Robertson

et al. 2016

Journal of Clinical Gastroenterology

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Gastroesophageal reflux disease is one of the commonest chronic conditions in the western world and its prevalence is increasing worldwide. The discovery of the acid pocket explained the paradox of acid reflux occurring more frequently in the postprandial period despite intragastric acidity being low due to the buffering effect of the meal. The acid pocket was first described in 2001 when it was detected as an area of low pH immediately distal to the cardia using dual pH electrode pull-through studies 15 minutes after a meal. It was hypothesized that there was a local pocket of acid close to the gastroesophageal junction that escapes the buffering effect of the meal, and that this is the source of postprandial acidic reflux. The presence of the acid pocket has been confirmed in other studies using different techniques including high-resolution pHmetry, Bravo capsule, magnetic resonance imaging, and scintigraphy. This review aims to describe what we know about the acid pocket including its length, volume, fluid constituents, and its relationship to the lower esophageal sphincter and squamocolumnar junction. We will discuss the possible mechanisms that lead to the formation of the acid pocket and examine what differences exist in patients who suffer from acid reflux. Treatments for reflux disease that affect the acid pocket will also be discussed.

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Definition and Pathophysiology of Gastroesophageal Reflux Disease

Fuchs

2020

Management of Gastroesophageal Reflux Disease

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Paradox of gastric cardia: it becomes more acidic following meals while the rest of stomach becomes less acidic

Abstract: Whereas the rest of the stomach shows a marked fall in acidity on ingesting a meal, the cardia paradoxically increases in acidity to become the most acidic region throughout the postprandial period.

Cited by 43 publications

References 25 publications

The Acid Pocket: A Target for Treatment in Reflux Disease?

The Acid Pocket: A Target for Treatment in Reflux Disease?

The Role of the Acid Pocket in Gastroesophageal Reflux Disease

Definition and Pathophysiology of Gastroesophageal Reflux Disease

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