Back to Search
Start Over
The Acid Pocket: A Target for Treatment in Reflux Disease?
- Source :
- American Journal of Gastroenterology. 108:1058-1064
- Publication Year :
- 2013
- Publisher :
- Ovid Technologies (Wolters Kluwer Health), 2013.
-
Abstract
- The nadir esophageal pH of reflux 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 reflux in healthy individuals and gastroesophageal reflux 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 film”, 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 reflux 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.
- Subjects :
- medicine.medical_specialty
Supine position
medicine.medical_treatment
610 Medicine & health
Ph monitoring
Gastroenterology
03 medical and health sciences
0302 clinical medicine
Antacid
Internal medicine
medicine
2715 Gastroenterology
Esophageal mucosa
Hepatology
business.industry
Reflux
medicine.disease
digestive system diseases
10219 Clinic for Gastroenterology and Hepatology
Postprandial
030220 oncology & carcinogenesis
GERD
Gastric acid
2721 Hepatology
030211 gastroenterology & hepatology
business
Subjects
Details
- ISSN :
- 00029270
- Volume :
- 108
- Database :
- OpenAIRE
- Journal :
- American Journal of Gastroenterology
- Accession number :
- edsair.doi.dedup.....956432e33765f82b11c8e477e7cbc5d6