Brief Article
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World J Gastroenterol. Nov 21, 2010; 16(43): 5496-5501
Published online Nov 21, 2010. doi: 10.3748/wjg.v16.i43.5496
Gastric juice acidity in upper gastrointestinal diseases
Pei-Jung Lu, Ping-I Hsu, Chung-Hsuan Chen, Michael Hsiao, Wei-Chao Chang, Hui-Hwa Tseng, Kung-Hung Lin, Seng-Kee Chuah, Hui-Chun Chen
Pei-Jung Lu, Institute of Clinical Medicine, National Cheng Kung University, Tainan 701, Taiwan, China
Ping-I Hsu, Kung-Hung Lin, Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, National Yang-Ming University, Kaohsiung 813, Taiwan, China
Chung-Hsuan Chen, Michael Hsiao, Wei-Chao Chang, Genomics Research Center, Academic Sinica, Taipei 115, Taiwan, China
Hui-Hwa Tseng, Department of Pathology, Kaohsiung Veterans General Hospital and National Yang-Ming University, Kaohsiung 813, Taiwan, China
Seng-Kee Chuah, Division of Gastroenterology, Chang Gung Memorial Hospital, Kaohsiung Medical Center, College of Medicine, Chang Gung University, Kaohsiung 833, Taiwan, China
Hui-Chun Chen, Department of Radiation Oncology, Chang Gung Memorial Hospital, Kaohsiung Medical Center, College of Medicine, Chang Gung University, Kaohsiung 833, Taiwan, China
Author contributions: Chen HC designed the study; Lu PJ conducted the tests and analyzed the data; Hsu PI, Lin KH and Chuah SK enrolled patients and colleted the specimens; Chen CH, Hsiao M, Chang WC and Tseng HH controlled the quality of tests.
Supported by Research grant NSC-96-2314-B-075B-009 from the National Science Council, Taiwan
Correspondence to: Dr. Hui-Chun Chen, Department of Radiation Oncology, Chang Gung Memorial Hospital, Kaohsiung Medical Center, College of Medicine, Chang Gung University, Kaohsiung 833, Taiwan, China. williamhsup@yahoo.com.tw
Telephone: +886-7-3468233 Fax: +886-7-3468237
Received: January 2, 2010
Revised: April 11, 2010
Accepted: April 18, 2010
Published online: November 21, 2010
Abstract

AIM: To search the independent factors determining gastric juice acidity and to investigate the acidity of gastric juices in various benign and malignant upper gastrointestinal diseases.

METHODS: Fasting gastric juice acidity of 165 healthy subjects and 346 patients with esophageal ulcer (n = 21), gastric ulcer (n = 136), duodenal ulcer (n = 100) or gastric cancer (n = 89) were measured and compared. Additionally, gastric specimens were taken from the antrum and body for rapid urease test and histological examination.

RESULTS: Multivariate analysis revealed that bile stain of gastric juice, high acute inflammatory score of the corpus, and atrophy of the corpus were independent risk factors for the development of gastric hypoacidity with odds ratios of 3.1 (95% CI: 1.3-7.3), 3.1 (95% CI: 1.2-7.9) and 3.5 (95% CI: 1.3-9.2). Esophageal ulcer and duodenal ulcer patients had a lower pH level (1.9 and 2.1 vs 2.9, both P < 0.05) of gastric juices than healthy subjects. In contrast, gastric ulcer and gastric cancer patients had a higher pH level (3.4 and 6.6 vs 2.9, both P < 0.001) than healthy controls. Hypoacidity existed in 22%, 5%, 29%, 5% and 88% of healthy subjects, esophageal ulcer, gastric ulcer, duodenal ulcer and gastric cancer patients, respectively.

CONCLUSION: Bile reflux, atrophy and dense neutrophil infiltrate of the corpus are three independent factors determining the acidity of gastric juice.

Keywords: Acidity; Gastric juice; Gastric cancer; Peptic ulcer; Esophageal ulcer