Advertisement

Digestive Diseases and Sciences

, Volume 56, Issue 6, pp 1735–1742 | Cite as

Impact of Acid Suppression on Upper Gastrointestinal pH and Motility

  • Whitney Michalek
  • John R. Semler
  • Braden Kuo
Original Paper

Abstract

Background

Proton pump inhibitors (PPIs), widely prescribed to patients with upper gastrointestinal symptoms, alter intragastric pH, and may affect upper gastrointestinal transit and motility parameters in addition to affecting the ability to determine Wireless Motility Capsule (WMC) gastric emptying time.

Aim

To assess PPI effect on motility parameters of the upper gastrointestinal tract and to determine if PPIs confound ability of WMC to measure gastric emptying time.

Methods

Twenty healthy subjects were treated with esomeprazole 40 mg bid for 1 week. Another 50 healthy subjects underwent evaluation in absence of PPIs. All subjects underwent WMC test after meal ingestion. After a rapid, sustained luminal pH rise ≥ 0.5 pH units, marking potential gastric emptying time of WMC, an abdominal X-ray (KUB) was taken for gastric emptying time confirmation. Mean pH, pressure and transit time were compared between PPI-treated and untreated groups.

Results

There was no difference in gastric emptying time, small bowel transit time (SBTT), or pressure profiles between the groups. The pH in all cases rose ≥ 0.5 pH units. Distal small bowel pH was significantly lower in subjects on PPIs. Gastric emptying time was identified in all subjects treated with PPIs. Pressure and slope criteria were developed to confirm the time of emptying.

Conclusion

PPI therapy does not have a significant impact on upper gastrointestinal transit and motility but it does decrease distal small bowel pH. The medication reduced the magnitude of pH change at gastric emptying time but using additional criteria based on slope and contraction frequency, WMC was able to measure gastric emptying time in all patients treated with PPIs.

Keywords

Stomach and duodenum Gastric emptying Motility Acidity (intragastric) 

Notes

Acknowledgments

This study was funded in part by The Smart Pill Corporation, grant number 208598, also in part by the National Institute of Health, grant number 218969, and International Foundation for Functional Gastrointestinal Disorders.

References

  1. 1.
    Dressman JB, Berardi RR, Dermentzoglou LC, et al. Upper gastrointestinal (GI) pH in young, healthy men and women. Pharm Res. 1990;7(7):756–761.PubMedCrossRefGoogle Scholar
  2. 2.
    Castell D, Bagin R, Goldlust B, Major J, Hepburn B. Comparison of the effects of immediate-release omeprazole powder for oral suspension and pantoprazole delayed-release tablets on nocturnal acid breakthrough in patients with symptomatic gastro-oesophageal reflux disease. Aliment Pharmacol Ther. 2005;21(12):1467–1474.PubMedCrossRefGoogle Scholar
  3. 3.
    Jacobson BC, Ferris TG, Shea TL, Mahlis EM, Lee TH, Wang TC. Who is using chronic acid suppression therapy and why? Am J Gastroenterol. 2003;98(1):51–58.PubMedCrossRefGoogle Scholar
  4. 4.
    Kuo B, Viazis N, Bahadur S, et al. Non-invasive simultaneous measurement of intra-luminal pH and pressure: assessment of gastric emptying and upper GI manometry in healthy subjects. Neurogastroenterol Motil. 2004; 16:666, #61.Google Scholar
  5. 5.
    Parkman HP, Urbain JL, Knight LC, et al. Effect of gastric acid suppressants on human gastric motility. Gut. 1998;42(2):243–250.PubMedCrossRefGoogle Scholar
  6. 6.
    Locke GR, Talley NJ, Weaver AL, Zinsmeister AR. A new questionnaire for gastroesophageal reflux disease. Mayo Clin Proc. 1994;69(6):539–547.PubMedGoogle Scholar
  7. 7.
    Faegenburg D, Kryle LS, Kashiwabara H, Doctor NM, Pai P. Intestinal obstruction caused by ingestion of a Heidelberg capsule: report of a case. Am J Gastroenterol. 1985;80(10):787–789.PubMedGoogle Scholar
  8. 8.
    Fleischer DE, Leighton JA, Sharma VK, Heigh RI. Video capsule endoscopy (VCE) is useful in the evaluation of unexplained abdominal pain (AP). Gastroenterology. 2003;200(Part 2):245.CrossRefGoogle Scholar
  9. 9.
    Jones BH, Fleischer DE, Sharma VK, et al. Yield of repeat wireless video capsule endoscopy in patients with obscure gastrointestinal bleeding. Am J Gastroenterol. 2005;100(5):1058–1064.PubMedCrossRefGoogle Scholar
  10. 10.
    Rao SS, Kuo B, McCallum RW, et al. Investigation of colonic and whole gut transit with wireless motility capsule and radioopaque markers in constipation. Clin Gastroenterol Hepatol. 2009;7(5):537–544.PubMedCrossRefGoogle Scholar
  11. 11.
    Evans DF, Pye G, Bramley R, Clark AG, Dyson TJ, Hardcastle JD. Measurement of gastrointestinal pH profiles in normal ambulant human subjects. Gut. 1988;29(8):1035–1041.PubMedCrossRefGoogle Scholar
  12. 12.
    Miner P Jr, Katz PO, Chen Y, Sostek M. Gastric acid control with esomeprazole, lansoprazole, omeprazole, pantoprazole, and rabeprazole: a five-way crossover study. Am J Gastroenterol. 2003;98(12):2616–2620.PubMedCrossRefGoogle Scholar
  13. 13.
    Mojaverian P, Chan K, Desai A, John V. Gastrointestinal transit of a solid indigestible capsule as measured by radiotelemetry and dual gamma scintigraphy. Pharm Res. 1989;6(8):719–724.PubMedCrossRefGoogle Scholar
  14. 14.
    Mojaverian P, Ferguson RK, Vlasses PH, et al. Estimation of gastric residence time of the Heidelberg capsule in humans: effect of varying food composition. Gastroenterology. 1985;89(2):392–397.PubMedGoogle Scholar
  15. 15.
    Shuster M, Crowell MD, Koch KL. Shuster atlas of gastrointestinal motility in health and disease. 2nd ed. Ontario: BC Decker Inc; 2002.Google Scholar
  16. 16.
    Zarate N, et al. Accurate localisation of a fall in pH within the ileo-caecal region: validation using a dual scintigraphic technique. Am J Physiol Gastrointest Liver Physiol. 2010 [Epub ahead of print].Google Scholar
  17. 17.
    Cooke AR. Duodenal acidification: role of first part of duodenum in gastric emptying and secretion in dogs. Gastroenterology. 1974;67(1):85–92.PubMedGoogle Scholar
  18. 18.
    Hunt JN, Knox MT. The slowing of gastric emptying by four strong acids and three weak acids. J Physiol. 1972;222(1):187–208.PubMedGoogle Scholar
  19. 19.
    Maqbool S, Parkman HP, Friedenberg FK. Wireless capsule motility: comparison of the SmartPill GI monitoring system with scintigraphy for measuring whole gut transit. Dig Dis Sci. 2009;54(10):2167–2174.PubMedCrossRefGoogle Scholar
  20. 20.
    Kuo B, McCallum RW, Koch KL, et al. Comparison of gastric emptying of a nondigestible capsule to a radio-labelled meal in healthy and gastroparetic subjects. Aliment Pharmacol Ther. 2008;27(2):186–196.PubMedCrossRefGoogle Scholar
  21. 21.
    Cassilly D, et al. Gastric emptying of a non-digestible solid: assessment with simultaneous SmartPill pH and pressure capsule, antroduodenal manometry, gastric emptying scintigraphy. Neurogastroenterol Motil. 2008;20(4):311–319.PubMedCrossRefGoogle Scholar
  22. 22.
    Lombardo L, Foti M, Ruggia O, Chiecchio A. Increased incidence of small intestinal bacterial overgrowth during Proton Pump Inhibitor therapy. Clin Gastroenterol Hepatol. 2010;8(6):504–508.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  1. 1.Massachusetts General HospitalBostonUSA
  2. 2.SmartPill CorporationBuffaloUSA

Personalised recommendations