The aim of this study was to evaluate the effect of preoperative anxiety on the gastric pH and volume. We studied 96 female patients aged 16-60 yr who underwent elective gynecological surgery. We classified the subjects into 2 groups, those presenting preoperative anxiety scores using visual analogue scale (VAS, 0-10) less than 5 (L-group, n=59), and those with 5 and more (H-group, n=37). Immediately after tracheal intubation, gastric contents were aspirated using a 14-F multiorifice nasogastric tube. The gastric acidity and volume of the two groups were not statistically different. Mean pH were 3.0+/-1.8 and 3.0+/-2.0 in each group (L-group and H-group) and mean gastric volume (mL) were 15.3 +/-11.7 and 11.8 +/-11.8, respectively. Nine (15.3%) patients in the L-group were considered to be 'at risk i.e. gastric pH <2.5 and volume >25 mL' and one patient (2.7%) in the H-group (p<0.05). The mean serum gastrin concentrations in both groups were similar (21.6+/-9.8 vs. 20.2+/-11.0 pg/mL). The pH and volume of preoperative gastric contents were not correlated with the preoperative anxiety. The results suggest that a low level of preoperative anxiety can be considered a risk factor for aspiration pneumonitis.
Adolescent ; Adult ; Anxiety/*metabolism ; Female ; *Gastric Acidity Determination ; Gastric Juice/metabolism ; Humans ; Middle Aged

OBJECTIVETo investigate mechanism and relation of some disorder motive forces of digest system in patients with liver cirrhosis.

METHODSPlasma vasoactive intestinal peptide (VIP), gastrin and motilin (MTL), electrogastrogram (EGG) and pH value of gastric juice in 24 hours; gastric elimination time by isotope. All above factors have been determined in patients with liver cirrhosis and analyzed with multiple linear regressions. While a group of normal cases has been observed as control.

RESULTSCompared to the control group, higher level of VIP and Gastrin and lower MTL down were observed in liver cirrhosis group (Plasma VIP, Gastrin and MTL are 14.8+/-4.8, 58.6+/-29.8 and 360+/-54.2 separately, t=5.181, 0.05, t=3.871, 0.01 and t=5.529, 0.05 separately). The EGG dominant frequency (DF) and dominant power (DP) decreased around diet; normal slow wave number (N%) decreased and gastric excretion time prolonged, lower bradygastrias (B%) and pH value of 24 hours gastric juice denoted the incline of return movement, there are remarked different with 0.05 or 0.01 separately. Throughout analyzing these factors with multiple linear regressions, there are remarkable relationship between liver cirrhosis and pH value of gastric juice; gastrointestinal hormone and EGG with 0.05 or 0.01.

CONCLUSION(1) There are remarkable gastro esophageal function abnormal which has been conveyed by disorder gastric electric physiology and gastric elimination time in patients with liver cirrhosis. It is suggested that unusual gastrointestinal hormone played an important role during these abnormal process. (2) There is remarkable changing of pH value of 24 hours gastric juice denoted the opposite movement of gastroduodenal juice in patients with liver cirrhosis.

Female ; Gastric Acidity Determination ; Gastric Emptying ; Gastrointestinal Motility ; Humans ; Liver Cirrhosis ; physiopathology ; Male ; Middle Aged ; Vasoactive Intestinal Peptide ; blood

Ambulatory 24-hr esophageal pH monitoring is considered the gold standard for diagnosing gastroesophageal reflux disease. The aim of this study was to establish normal values for gastroesophageal acid exposure in healthy Koreans. Fifty healthy volunteers (24 males and 26 females; mean age, 45 yr) without reflux symptoms and without reflux esophagitis or hiatal hernia on upper endoscopy underwent ambulatory 24-hr esophageal pH monitoring after esophageal manometry. The 95th percentiles for the reflux parameters were: the percent total time pH <4, 3.7%; the percent upright time pH <4, 5.7%; the percent supine time pH <4, 1.0%; the number of reflux episodes with pH <4, 76.5; the number of reflux episodes with pH <4 for >5 min, 1.5; the duration of the longest episode, 12.5 min; and the composite score, 14.2. Age and gender were not associated with any of the pH parameters. In conclusion, physiological gastroesophageal reflux occurs in healthy Koreans. These normal esophageal pH values will provide reference data for clinical and research studies in Korea.
Adult ; Age Factors ; Aged ; *Esophageal pH Monitoring ; Female ; Gastric Acidity Determination ; Gastroesophageal Reflux/*diagnosis ; Humans ; Hydrogen-Ion Concentration ; Korea ; Male ; Middle Aged ; Reference Values ; Sex Factors ; Time Factors

OBJECTIVETo study the effects of bifidobacterium on respiratory and gastrointestinal tracts in neonates receiving mechanical ventilation.

METHODSThe eligible neonates were randomly assigned into two groups: observed (n=38) and control (n=43). The observed group was given bifidobacteria daily (one capsule per time, for 7 days) by nasal feeding from the next day after mechanical ventilation. Gastric pH, gastric bacteria colonization, feeding intolerance, weight gain, the incidence of ventilator-associated pneumonia (VAP), and the homology between the bacteria isolated from intra-gastric colonization with those causing VAP were observed.

RESULTSThe incidence of gastric pH≤3 in the observed group was significantly higher than that in the control group 3, 5 and 7 days after mechanical ventilation (P<0.01). The rate of gastric bacteria colonization in the observed group was significantly lower than that in the control group 5 and 7 days after mechanical ventilation (P<0.01). The incidences of feeding intolerance and VAP in the observed group were significantly lower than those in the control group (P<0.05, P<0.01, respectively). The rate of homology of the bacteria isolated from intra-gastric colonization with those causing VAP in the observed group was significantly lower than that in the control group (P<0.01). There were no significant differences in the weight gain between the two groups.

CONCLUSIONSBifidobacterium can decrease gastric pH, gastric bacteria colonization and feeding intolerance, thus blocks the infection route "stomach-oropharynx-respiratory tract" indirectly and decreases the incidence of endogenous VAP in neonates receiving mechanical ventilation.

Bifidobacterium ; physiology ; Female ; Gastric Acidity Determination ; Gastrointestinal Tract ; microbiology ; Humans ; Infant, Newborn ; Male ; Pneumonia, Ventilator-Associated ; epidemiology ; prevention & control ; Respiration, Artificial ; adverse effects ; Weight Gain

BACKGROUND/AIMS: Data from previous studies on gastric acid secretion and the prevalence of H. pylori in liver cirrhosis patients remain poorly defined. H. pylori is a potential source of NH3, but the possible role of H. pylori in hepatic encephalopathy is not clear. The purpose of this study was to compare gastric acid secretion, the impact of H. pylori infection, and the production of NH3 between cirrhotic patients and healthy, matched controls. METHODS: Twenty-nine patients with liver cirrhosis (HBV, n=12; Alcohol, n=12; HCV, n=5) were matched with 33 healthy persons for age and sex. None of the patients or controls were being treated with antacids, H2-receptor blockers or proton pump inhibitors. The pH and NH3 concentration was measured in gastric juice obtained by endoscopy. H. pylori infection was diagnosed using the rapid urease test. The level of NH3 in venous blood was also measured. RESULTS: The average gastric pH was significantly higher in cirrhosis patients compared to controls (3.91 vs. 2.99, P<0.05). In addition, the prevalence of hypochlorhydria (defined as pH>4) was significantly greater in cirrhosis patients (45 vs. 21%, P<0.05). In contrast, the prevalence of H. pylori infection (62% vs. 58%) and gastric NH3 concentrations (3.4 vs. 3.3 mM/L) were similar between both groups. However, venous NH3 levels were significantly higher in cirrhotics than in controls (63.1 vs. 25.2 micro M/L, P<0.05). The patients with H. pylori infection had significantly higher gastric NH3 concentration (3.8 vs. 1.6 mM/L) and gastric pH (3.87 vs. 2.76, P<0.05) than those without infection, but no significant difference in venous NH3 levels were detected (39.6 vs. 48.1 micro M/L). In patients with cirrhosis, the presence of H. pylori infection was not correlated with either gastric or blood NH3 levels. CONCLUSIONS: The gastric pH of liver cirrhosis patients is higher than that of controls and a larger proportion of cirrhotic patients have hypochlorhydria. The prevalence of H. pylori in liver cirrhosis patients was similar to that in controls and no correlation was found between gastric and blood NH3 levels. Thus, H. pylori infection does not seem to play a major role in generation of elevated NH3 associated with hepatic encephalopathy.
Achlorhydria/complications ; Ammonia/analysis ; English Abstract ; Female ; Gastric Acid/secretion ; *Gastric Acidity Determination ; Helicobacter Infections/*complications/physiopathology ; *Helicobacter pylori ; Humans ; Hydrogen-Ion Concentration ; Liver Cirrhosis/*metabolism/microbiology/physiopathology ; Male ; Middle Aged

BACKGROUND/AIMS: pH monitoring of the esophagus has been considered as the gold standard for the measurement of acid reflux. However, it has several limitations related to its inability to detect nonacid reflux. We conducted this study to characterize the proportion of acid and non-acid reflux events in children using pH-multichannel intraluminal impedance (MII) monitoring and to determine the correlation of the symptom index with non-acid and acid reflux events. METHOS: Seventy-five children, aged from 9 days to 12 years, underwent 24 hour pH-MII monitoring at Asan Medical Center from March 2006 to June 2007. We investigated the underlying disease and main problems related to gastroesophageal reflux (GER) of the patients, the number of acid and nonacid reflux, symptom index, symptom sensitivity index in pH monitoring only and pH-MII monitoring. RESULTS: While 2,247 reflux events were detected by MII, and only 967 reflux events were detected by pH probe alone. The percentage of acid reflux was 43% (967) and that of non-acid was 57% (1,280). The non-acid reflux increased at postprandial time (p<0.001). The symptom index increased when measured by pH-MII (31.1%) compared with those by pH probe alone (8.2%) (p=0.003). CONCLUSIONS: This study suggests that significant number of GER include non-acid reflux which cannot be detected by pH probe alone, therefore combining pH with MII monitoring is a valuable diagnostic tool for diagnosing GER in children.
Chi-Square Distribution ; Child ; Child, Preschool ; Electric Impedance ; *Esophageal pH Monitoring ; Female ; Gastric Acidity Determination ; Gastroesophageal Reflux/*diagnosis/physiopathology ; Humans ; Infant ; Infant, Newborn ; Male ; Severity of Illness Index ; Time Factors

OBJECTIVETo investigate the efficacy and safety of famotidine treatment for stress ulcers in neonates.

METHODSFifty-four neonates with stress ulcers from 2001 to 2006 were enrolled. Seven cases were confirmed with stress ulcers by gastroscopy. Famotidine was administered intravenously at a dosage of 0.5 mg/kg every other 12 hrs. After cessation of hematemesis and vomiting, famotidine was administered once a day for two days. Primary diseases and complications were concurrently treated. Clinical symptoms and gastric pH were assessed before and after famotidine treatment. Possible adverse effects of famotidine treatmentdouble ended arrowrelated were observed.

RESULTSAfter 24 hrs of famotidine treatment, hematemesis and vomiting ceased in 52 patients (96.3%). Clinical symptoms disappeared in all of the 54 patients 48 hrs after famotidine treatment. Gastric pH value increased 6, 12, 24, 36 and 48 hrs after famotidine treatment from 2.07+/-0.22 (before treatment) to 5.01-5.15 (P<0.01). All of the 54 patients were successfully treated. Famotidine treatment did not lead to abnormal respiration, heart rate and blood pressure. Loss of appetite, nausea, vomiting, diarrhea, constipation and rashes were not seen after famotidine treatment. There were significant differences in white cell count, platelet count and hepatic enzyme levels before and after famotidine treatment. An augmented side effect of the other drugs concurrently used due to famotidine treatment was not noted.

CONCLUSIONSFamotidide is effective and safe for the treatment of stress ulcers in neonates.

Anti-Ulcer Agents ; therapeutic use ; Famotidine ; adverse effects ; therapeutic use ; Female ; Gastric Acidity Determination ; Histamine H2 Antagonists ; therapeutic use ; Humans ; Infant, Newborn ; Male ; Stomach Ulcer ; drug therapy ; Stress, Psychological ; complications

OBJECTIVETo evaluate the clinical application of 24-hour esophageal multichannel intraluminal impedance-pH monitoring technique in preterm infants.

METHODThis study enrolled 28 preterm (male 20, female 8) infants with symptoms suggestive of gastroesophageal reflux (GER) (frequent regurgitations, apnea, or transcutaneous oxygen saturation decreased). They had postmenstrual age from 26 to 32 weeks, median (28.9 ± 1.9)weeks, had birth weight from 850 to 1 700 g, median (1 250.4 ± 272.8)g, range 850-1700 g, and were studied at corrected gestational age from 28 to 40 weeks, median (34.5 ± 2.3)weeks. Combined measurement of esophageal pH and impedance was performed. The 24-hour pH-impedance recording was uploaded onto a portable storage card and for computer-assisted manual analysis, using a specialized software program. When values were distributed normally, they were presented as mean and standard deviation, compared using t test. When values were not distributed normally, they were presented as median, minimum and maximum. Median values were compared using the Mann-Whitney U non-parametric test. SPSS 17.0 software was used.

RESULTIn 28 preterm infants, 71.4% (20/28) had pathological acid refluxes with pH monitor, while 100% with combined measurement of esophageal pH and impedance. Gestational age, birth weight, corrected gestational age had no association with acid GER. Frequent regurgitations, apnea, or transcutaneous oxygen saturation decreased but there was no statistically significant difference between acid GER group and non-acid GER group. Eight cases had no pathological acid refluxes, but showed an increase of weakly acid refluxes than pathological acid refluxes group (P < 0.01) . The median number of reflux events in 24 hours for 28 cases was 64.5 (0-377) , 23.4% were acidic, while 76.4% were weakly acidic; 59.1% were liquid bolus refluxes, while 40.9% were mixed bolus refluxes. The positive ratio of symptoms related index and symptoms association probability were significantly increased combined measurement of esophageal pH and impedance versus pH monitor were used.

CONCLUSIONThe 24-hour esophageal impedance-pH monitoring technique was safe and had good tolerance. We confirmed that it detected more weakly acidic refluxes, liquid bolus refluxes, and mixed bolus refluxes. And it provided more evidence for explaining the relationship between GER and clinical manifestation.

Electric Impedance ; Esophageal pH Monitoring ; Esophagus ; physiopathology ; Female ; Gastric Acidity Determination ; Gastroesophageal Reflux ; diagnosis ; physiopathology ; Humans ; Infant, Newborn ; Infant, Premature ; Infant, Premature, Diseases ; diagnosis ; physiopathology ; Male ; Monitoring, Physiologic ; methods ; Sensitivity and Specificity

OBJECTIVETo investigate the changes of perioperative serum levels of interleukin-6 (IL-6), C-reactive protein (CRP), and cortisol, as well as gastric intramucosal pH (pHi) and plasma lactate, aiming to compare systemic changes and tissue perfusion during colorectal and orthopaedic surgical procedures.

METHODSTwenty patients were randomly assigned to two groups, 10 cases of operation on vertebral canal, 10 cases of colorectal radical operation. Venous blood was drawn at 1 day before operation, 2, 4, and 6 hours following skin incision, and 1 day after operation, in order to measure serum IL-6, CRP, and cortisol. pHi and plasma lactate were also measured at the same time points.

RESULTSSerum concentrations of IL-6 and cortisol increased gradually following operation, reaching the peak value at 6 hours from the beginning of operation. CRP was not detectable until the first day after operation. Peak concentration of IL-6 had positive relationship with CRP. These variables changed more significantly in colorectal group than that in orthopaedic group (P < 0.05). pHi decreased gradually, reaching the lowest level at 4 hours from the beginning of operation, and to more extent in colorectal group than that in orthopaedic group (P < 0.05).

CONCLUSIONIL-6 may reflect tissue damage more sensitively than CRP. Colorectal surgery might induce systemic disorder to more extent, in terms of immuno-endocrinal aspect as well as tissue perfusion, reflected with pHi.

Adult ; Aged ; C-Reactive Protein ; metabolism ; Colorectal Neoplasms ; blood ; physiopathology ; surgery ; Female ; Gastric Acidity Determination ; Gastric Mucosa ; metabolism ; Humans ; Hydrocortisone ; blood ; Hydrogen-Ion Concentration ; Interleukin-6 ; blood ; Intervertebral Disc Displacement ; blood ; physiopathology ; surgery ; Lactic Acid ; blood ; Male ; Middle Aged ; Perioperative Care ; methods ; Spinal Stenosis ; blood ; physiopathology ; surgery

Gastroesophageal reflux disease (GERD) often presents as typical symptoms such as heartburn or acid regurgitation. However, a subgroup of patients presents a collection of symptoms and signs that are not directly related to esophageal damage. These are known collectively as the extraesophageal manifestations of GERD, such as non-cardiac chest pain, laryngitis, chronic cough, hoarseness, asthma or dental erosion. They have a common pathophysiology, involving microaspiration of acid into the larynx and pharynx, and vagally mediated bronchospasm and laryngospasm. The role of extraesophageal reflux in such disorders is underestimated due to often silent symptoms and difficult confirmation of diagnosis. Endoscopy and pH monitoring are insensitive and therefore not useful in many patients as diagnostic modalities. Thus, anti-secretory therapy by proton pump inhibitor is used as both a diagnostic trial and as a therapy in the majority. Attention to optimizing therapy and judicious use of endoscopy and reflux monitoring are needed to maximize treatment success.
Anti-Ulcer Agents/administration & dosage ; Asthma/diagnosis/etiology ; Cough/diagnosis/etiology ; Esophageal pH Monitoring ; Gastric Acidity Determination ; Gastroesophageal Reflux/*diagnosis/etiology/therapy ; Hoarseness/diagnosis/etiology ; Humans ; Laryngitis/diagnosis/etiology ; Omeprazole/administration & dosage ; Prognosis ; Proton Pump Inhibitors/therapeutic use ; Tooth Erosion/diagnosis/etiology