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Continuous gastric pH monitoring offers the opportunity to evaluate gastric acid secretion
in humans without the need for collection of gastric aspirates. However, gastric emptying
may be an important variable for the accurate measurement of gastric acid secretion
using continuous gastric pH monitoring. We conducted an in vitro study (phase I) to
evaluate the effect of gastric emptying on gastric pH. The in vitro study used a laboratory
model in which continuous pH monitoring of a standard formula (Nutramigen, 100 mL)
in a reservoir was performed while varying both the reservoir emptying rate (10% to
80%) over 1 hour and the amount of added acid (2 to 15 mEq/h: in vivo equivalent of
6 to 45 mEq/m2 BSA/h). An in vivo study (phase II) was then performed in 28 infants less than 6
months of age who had gastroesophageal reflux (GER) documented by 18- to 24-hour esophageal
pH monitoring. At the end of esophageal pH monitoring, the pH electrode was advanced
into the stomach for measurement of gastric pH continuously for 2 hours after a feeding
of Nutramigen formula (300 mL/m2 BSA). Each patient also had a radionuclide gastric emptying study performed with
the same volume of Nutramigen formula. In the in vitro model, the reservoir pH (%
time pH <4) was proportional to the reservoir emptying rate only when acid was added
at <15 mEq/h (<45 mEq/m2 BSA/h). Reservoir pH was independent of reservoir emptying rate when acid was added
at 15 mEq/h (45 mEq/m2 BSA/h). Using the in vitro model as a reference for the in vivo studies, postprandial
gastric acid secretion was estimated at>45 mEq/m2 BSA/h in 6 of 28 (21%) infants and <9 mEq/m2 BSA/h in 15 of 28 (54%) infants with GER. In conclusion, reservoir emptying affected
the measurement of reservoir pH at acid secretion levels under 15 mEq/h (45 mEq/m2 BSA/h). In most infants, any measurement of gastric acid secretion by continuous
gastric pH monitoring must also account for the rate of gastric emptying.
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Footnotes
*Presented at the 24th Annual Meeting of the Pacific Association of Pediatric Surgeons, Hong Kong, May 20–24, 1991.
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Copyright
© 1992 W.B. Saunders Company. All right reserved. Published by Elsevier Inc.
