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World J Gastroenterol. Aug 14, 2006; 12(30): 4892-4896
Published online Aug 14, 2006. doi: 10.3748/wjg.v12.i30.4892
Prolonged intestinal mucosal acidosis is associated with multiple organ failure in human acute pancreatitis: Gastric tonometry revisited
Gabor C Kovacs, Geza Telek, Janos Hamar, Jozsef Furesz, Janos Regoly-Merei
Gabor C Kovacs, Geza Telek, Janos Regoly-Merei, 3rd Department of Surgery, Semmelweis University Budapest, Hungary
Janos Hamar, Department of Experimental Research, National Institute of Traumatology, Budapest, Hungary
Jozsef Furesz, Institute of Health Protection, Hungarian Defense Forces, Budapest, Hungary
Author contributions: All authors contributed equally to the work.
Supported by the Hungarian National Scientific Research Fund (OTKA), No. T 016630, and the Hungarian Ministry of Health (ETT), No. 276/2001
Correspondence to: Dr. Gabor C Kovacs, 3rd Department of Surgery, Semmelweis Egyetem, 1096 Budapest Nagyvárad tér 1, Hungary. gkov@seb3.sote.hu
Telephone: +36-1-4555700
Received: November 21, 2005
Revised: November 29, 2005
Accepted: January 14, 2006
Published online: August 14, 2006
Abstract

AIM: To evaluate whether multiple determinations of intramucosal pH (pHi) in acute pancreatitis (AP) patients could provide additional information of the disease severity during early hospitalization.

METHODS: Twenty-one patients suffering from acute pancreatitis were monitored by gastric tonometry in the first 72 h after hospital admission.

RESULTS: In the survivor group (n = 15) the initially low pHi values returned to normal level (pHi ≥ 7.32) within 48 h (median pHi: d 1: 7.21; d 2: 7.32; d 3: 7.33). In contrast, pHi values in the non-survivor group n = 6) were persistently either below or in the low normal range (median pHi 7.12; 7.12; 7.07 respectively), but pHi differences between the two groups reached significance only after 24 h (P < 0.01). Mucosal acidosis detected at any time during the monitored period was associated with the emergence of single or multiple organ dysfunction (P < 0.01).

CONCLUSION: Prolonged gastric mucosal acidosis was associated with remote organ dysfunction and failure in Acute Pancreatitis, however, correlation with the fatal outcome became significant only 24 h after admission. Due to its non-invasive nature gastric tonometry may supplement the pro-inflammatory markers to achieve a multi-faceted monitoring of the disease.

Keywords: Acute pancreatitis; Human studies; Intramucosal pH; Mucosal barrier dysfunction; Septic complications; Bacterial translocation; Multiple organ dysfunction