The position of the acid pocket as a major risk factor for acidic reflux in healthy subjects and patients with GORD

Beaumont, Hanneke; Bennink, Roelof J.; Jong, Jan de; Boeckxstaens, Guy E.

doi:10.1136/gut.2009.178061

Cited by 173 publications

(200 citation statements)

References 43 publications

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“…Th e time course of the acid pocket also correlates well with the prevalence of postprandial acid refl ux events, which are reported to occur most frequently in the fi rst postprandial hour, in both healthy volunteers and GERD patients ( 19 ). 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.…”

Section: Reviewmentioning

confidence: 91%

“…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%

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

Kahrilas

McColl

Fox³

et al. 2013

American Journal of Gastroenterology

133

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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: Reviewmentioning

confidence: 91%

Section: Reviewmentioning

confidence: 99%

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

Kahrilas

McColl

Fox³

et al. 2013

American Journal of Gastroenterology

133

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“…36 Similarly, Beaumont S Sy ys st te em ma at ti ic c r re ev vi ie ew w: : w we ea ak kl ly y a ac ci id di ic c a an nd d w we ea ak kl ly y a al lk ka al li in ne e r re efl flu ux x i in n G GE ER RD D Aliment Pharmacol Ther 2010; 32: 334-343pocket in the stomach of patients with GERD, compared with healthy volunteers, as well as an increased number of acid reflux episodes in the postprandial period in both healthy volunteers and patients with GERD. 37 Our systematic review of the literature encountered several limitations. These included the absence in some studies of relevant baseline patient demographics, such as frequency and severity of reflux symptoms and whether or not these responded to PPI therapy, as well as inconsistencies between studies in the definitions and methods used to define associations between reflux episodes and reflux symptoms.…”

Section: Discussionmentioning

confidence: 99%

Systematic review: role of acid, weakly acidic and weakly alkaline reflux in gastro‐oesophageal reflux disease

Boeckxstaens

Smout

2010

Aliment Pharmacol Ther

119

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Aliment Pharmacol Ther 2010; 32: 334–343SummaryBackground The importance of weakly acidic and weakly alkaline reflux in gastro‐oesophageal reflux disease (GERD) is gaining recognition.Aim To quantify the proportions of reflux episodes that are acidic (pH <4), weakly acidic (pH 4–7) and weakly alkaline (pH >7) in adult patients with GERD, and to evaluate their correlation with symptoms.Methods Studies were identified by systematic PubMed and Embase searches. Data are presented as sample‐size weighted means and 95% confidence intervals.Results In patients with GERD taking a proton pump inhibitor (PPI), 80% (76–84%) of reflux episodes were weakly acidic or weakly alkaline and 83% (78–88%) of reflux symptom episodes were associated with weakly acidic or weakly alkaline reflux episodes. In patients with GERD not taking a PPI, 63% (59–67%) of reflux episodes were acidic and 72% (57–87%) of reflux symptom episodes were associated with acid reflux episodes. Six studies presented data separately for weakly alkaline reflux, which accounted for <5% of all reflux episodes, both on and off PPI therapy.Conclusions Weakly acidic reflux underlies the majority of reflux episodes in patients with GERD on PPI therapy, and is the main cause of reflux symptoms occurring despite PPI therapy.

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“…However, in patients with GERD, the acidified segment extends higher up into the lower esophageal sphincter and distal esophagus, especially in patients with large hiatal hernia. [4][5][6] Therefore, pharmacological intervention for the acid pocket will be issued. Alginates are natural polysaccharide polymers, that on contact with gastric acid, precipitate into a viscous gel of near neutral pH within minutes.…”

Section: Commentsmentioning

confidence: 99%

Proton Pump Inhibitors Reduce the Size and Acidity of the Gastric Acid Pocket (Clin Gastroenterol Hepatol 2014;12:1101-1107, e1)

2015

J Neurogastroenterol Motil

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The position of the acid pocket as a major risk factor for acidic reflux in healthy subjects and patients with GORD

Cited by 173 publications

References 43 publications

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

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

Systematic review: role of acid, weakly acidic and weakly alkaline reflux in gastro‐oesophageal reflux disease

Proton Pump Inhibitors Reduce the Size and Acidity of the Gastric Acid Pocket (Clin Gastroenterol Hepatol 2014;12:1101-1107, e1)

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