Assessment of gastric acidity by short-duration intragastric pH-monitoring with standardised breakfast in functional and some other dyspepsias

Abstract

Introduction Preliminary assessment of gastric secretion in the treatment of organic and functional dyspepsia may offer advantages over the empirical administration of proton pump inhibitors suggested by most clinical guidelines. Aim To develop a simplified pH-metric test with standardised meal, and on its basis to perform an assessment of the functional state of gastric secretion in the most common dyspepsias. Material and methods Serum pepsinogen 1 and 2 were used for reference. Intragastric pH-monitoring was performed during 45 min in basal phase and 135 min after provocative breakfast (507 kcal, 100 mg caffeine). Consecutive adults enrolled in the study were divided into groups: 1 – “Non-dyspeptic” – 30 persons; 2 – “Duodenal peptic ulcer” – 13; 3 – “GERD” – 82; and 4 – “Functional dyspepsia” – 125 patients. Results There was a moderate association between concentration of pepsinogen-1 and parameters of pH-monitoring. The best correlation coefficients were for the nadir pH in basal conditions and the time of acid neutralisation > 3.5 after the meal – r = –0.534 and r = –0.541, respectively ( p < 0.0001). Using these two parameters we considered discriminants for four patterns of acidity. Proposed criteria of Hipo-anacidity included an absence of active secretion of hydrochloric acid in basal (pHmin > 5) and postprandial phases, with the achievement of stable pH < 3.5 after 80 min from meal time. They showed sensitivity 88.9% and specificity 100%. In cases of a detected pattern of hyperacidity, these parameters were 80% and 66.67%, respectively. According to the prevalence of hyperacidic cases, the groups were ranked in the following order: duodenal ulcer (76.9%) – GERD (51.1%) – functional dyspepsia (40.8%) – non-dyspeptic (19.0%). Conclusions Acid production is increased among patients with functional dyspepsia. There is a small number of patients with functional dyspepsia (12.1%) with hypochlorhydria due to atrophic gastritis. The latter was independently associated with age > 50 years (OR = 20.139), symptoms of postprandial distress-syndrome (OR = 9.821), and signs of atrophy (OR = 5.914) after conventional endoscopy.

Korelasi antara Sarapan Pagi dengan Sindrom Dispepsia dan Aktivitas Fisik pada Anak Usia 10-12 tahun di Surakarta

“…Melewatkan atau tidak mengonsumsi sarapan dapat menjadi bagian dari kebiasaan makan yang tidak teratur, di mana seseorang mengonsumsi makanan secara berlebihan pada waktu tertentu atau bahkan tidak makan sama sekali pada waktu yang lain. Pola makan yang tidak konsisten seperti ini dapat berdampak pada keseimbangan asam lambung dan berperan dalam timbulnya sindrom dispepsia (Melashchenko, 2020).…”

Yoga Therapy in Functional Dyspepsia. A Narrative Review

“…Another factor that can impair gastric accommodation is increased duodenal acid exposure, probably through triggering duodeno-gastric reflexes [102,103]. Though studies suggest normal acid production in FD patients [104] and only an increase in the duodenal acid exposure due to slow motility, or impaired mucosal barrier, there are other studies which suggest increased acid production as well in a subset of patients [105].…”

“…Reduced anti-nociceptive role of the vagus nerve [110], corticosterone-induced increased excitability of dorsal root ganglion neurons [66,111], increased acid secretion [105] or increased acid exposure decreased due to slow gastroduodenal motility [112], as well as altered CNS pain processing [22,113] are implicated in gastric hypersensitivity.…”

Capsaicin: A Novel Approach to the Treatment of Functional Dyspepsia

“…[136] Instillation of hydrochloric acid into the stomach of healthy subjects induced FD-like symptoms. [137] Some studies have focused on the application of some gastric acid inhibition such as H 2 -receptor antagonists and proton pump inhibitors (PPIs). [138,139] However, these studies showed the opposite results.…”