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PPIs affected size, acidity, position of acid pocket in GERD patients

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Proton pump inhibitors may affect the size, acidity or position of the acid pocket in the stomach of patients with gastroesophageal reflux disease, which may contribute to treatment efficacy, according to recent study data.

Researchers analyzed a cohort of 36 patients with gastroesophageal reflux disease (GERD), half of whom were on proton pump inhibitors (PPIs), and half who stopped taking PPIs at least 7 days before the study. Patients on PPIs took them 30 minutes before the study. After a baseline scintigraphy, patients were given a standardized meal, and then concurrent scintigraphic, high-resolution manometry (HRM) and pH-impedance recordings were performed. The position of the acid pocket was measured for each reflux episode, and classified as below, above, or at the level of the diaphragm. Acid pockets were aspirated, and pH levels were measured.

The number of reflux episodes was not significant in patients taking PPIs (15 ± 2.6) and those not taking PPIs (14 ± 2.1), but reflux episodes were expectedly lower in patients taking PPIs (4.5 vs. 2; P=.04). In patients on PPIs the acid pocket was smaller compared with patients off PPIs (10 ± 1.3 cm² vs. 15 ± 0.9 cm²; P<.01), and with a position more frequently categorized as being below the diaphragm (60% ± 6.9% vs. 40% ± 6.5% of reflux episodes; P=.04). Risk for acidic reflux was lowest when the acid pocket was below the diaphragm (15% ± 5.5% off PPI; 7% ± 3% on PPI; P=.2) when compared with positions at level (76% ± 6.7% off PPI; 46% ± 12% on PPI; P=.11) or above the diaphragm (95% ± 3.9% off PPI; 49% ± 7.5% on PPI; P<.01). Acid pocket pH was greater in patients on PPIs (4; range, 1.6-5.9 vs. 0.9; range, 0.7-1.2; P<.001), which correlated with the pH of reflux events (r=0.72; P<.01).

In addition to evidence that PPI treatment affected the size, position and pH of the acid pocket, researchers said, more importantly, “during PPI treatment the acid pocket represents the reservoir for gastroesophageal reflux, and thus should be considered as a potential target for additional therapy.”

 Disclosure: The researchers report no relevant financial disclosures.