OBJECTIVE: The normal pattern of carbon dioxide (CO2) levels in the human stomach and small bowel after meals is unknown. The intraluminal carbon dioxide level is a sensitive and early marker for organ mucosal ischemia. CO2 levels in both the stomach and small bowel are influenced by multiple factors other than adequacy of perfusion. Gastric acid production, salivary bicarbonate and CO2 produced or absorbed by meals are the disturbing variables. Prolonged gastric (and jejunal) tonometry after meals can be of additional value in the work-up of patients suspected of (chronic) gastrointestinal ischemia. The purpose of this study was to challenge these problems using in vitro tested meals and a rigid acid-suppression regimen in a group of healthy subjects. MATERIAL AND METHODS: Standard meals were tested in vitro on the ability to produce and buffer CO2. Meals with the least CO2 variations were subsequently used in healthy subjects. Tonometry of the stomach and jejunum was performed for 24 h, with optimal and controlled acid suppression. RESULTS: Ten subjects were enrolled in the study. Acid production was sufficiently suppressed. The gastric PCO2 baseline (fasting) was 6.5 (1.0), and significantly lower than the jejunum PCO2 baseline of 7.6 (0.9) kPa. The gastric baseline during the day was 6.9 (1.6), and significantly lower than the gastric baseline during the night of 8.0 (1.8), suggesting a diurnal variation of PCO2. Increases in PCO2 levels were seen in all subjects, after meals and between meals. CONCLUSIONS: Prolonged gastric and jejunal tonometry is feasible in humans. PCO2 levels were seen to peak after, but also in-between, most meals. The diurnal variation in PCO2 might reflect reversible gastric mucosal ischemia.
OBJECTIVE: The normal pattern of carbon dioxide (CO2) levels in the human stomach and small bowel after meals is unknown. The intraluminal carbon dioxide level is a sensitive and early marker for organ mucosal ischemia. CO2 levels in both the stomach and small bowel are influenced by multiple factors other than adequacy of perfusion. Gastric acid production, salivary bicarbonate and CO2 produced or absorbed by meals are the disturbing variables. Prolonged gastric (and jejunal) tonometry after meals can be of additional value in the work-up of patients suspected of (chronic) gastrointestinal ischemia. The purpose of this study was to challenge these problems using in vitro tested meals and a rigid acid-suppression regimen in a group of healthy subjects. MATERIAL AND METHODS: Standard meals were tested in vitro on the ability to produce and buffer CO2. Meals with the least CO2 variations were subsequently used in healthy subjects. Tonometry of the stomach and jejunum was performed for 24 h, with optimal and controlled acid suppression. RESULTS: Ten subjects were enrolled in the study. Acid production was sufficiently suppressed. The gastric PCO2 baseline (fasting) was 6.5 (1.0), and significantly lower than the jejunum PCO2 baseline of 7.6 (0.9) kPa. The gastric baseline during the day was 6.9 (1.6), and significantly lower than the gastric baseline during the night of 8.0 (1.8), suggesting a diurnal variation of PCO2. Increases in PCO2 levels were seen in all subjects, after meals and between meals. CONCLUSIONS: Prolonged gastric and jejunal tonometry is feasible in humans. PCO2 levels were seen to peak after, but also in-between, most meals. The diurnal variation in PCO2 might reflect reversible gastric mucosal ischemia.
Authors: Désirée van Noord; Peter B Mensink; Pieter C Ter Borg; Peter M Pattynama; Hence J Verhagen; Ernst J Kuipers Journal: BMJ Case Rep Date: 2009-03-05
Authors: Désirée van Noord; Peter B F Mensink; Robert J de Knegt; Martine Ouwendijk; Jan Francke; Anneke J van Vuuren; Bettina E Hansen; Ernst J Kuipers Journal: Dig Dis Sci Date: 2010-07-15 Impact factor: 3.199
Authors: R W F ter Steege; H S Sloterdijk; R H Geelkerken; A B Huisman; J van der Palen; J J Kolkman Journal: World J Surg Date: 2012-04 Impact factor: 3.352
Authors: Jian Zhen Ou; Jeremy J Cottrell; Nam Ha; Naresh Pillai; Chu K Yao; Kyle J Berean; Stephanie A Ward; Danilla Grando; Jane G Muir; Christopher J Harrison; Udani Wijesiriwardana; Frank R Dunshea; Peter R Gibson; Kourosh Kalantar-Zadeh Journal: Sci Rep Date: 2016-09-16 Impact factor: 4.379
Authors: Peter B F Mensink; Robert H Geelkerken; Ad B Huisman; Ernst J Kuipers; Jeroen J Kolkman Journal: Dig Dis Sci Date: 2007-05-26 Impact factor: 3.199