Duodenal Contents Research Articles

Development of an indirect method for measuring porcine pancreatic lipase in human duodenal fluid

Patients with exocrine pancreatic insufficiency are usually treated with porcine pancreatic enzymes but the bioavailability of these enzymes in the gut remains a matter of discussion. In order to determine the duodenal availability of porcine pancreatic lipase (PPL) present in pancreatic extracts (PE) taken orally, we developed a method for quantifying PPL in samples containing both PPL and human pancreatic lipase (HPL). Total pancreatic lipase activity measurements using the pH-stat technique and tributyrin as substrate were combined with an HPL-specific ELISA. Based on the known specific activity of the purified HPL, its activity was deduced from the ELISA measurements, and the PPL activity was obtained by subtracting the HPL activity from the total pancreatic lipase activity. This assay was established and validated using various samples containing pure PPL and recombinant HPL or PE, mixed or not with human duodenal juice. Samples collected in vivo from patients treated with PE were also tested. It was found that PPL did not affect the HPL ELISA, and the indirect PPL assay gave a measurement accuracy of 6.6% with the samples containing pure PPL and 10% with those containing PE. This assay was also used successfully to discriminate between PPL and the endogenous HPL present in the duodenal contents of patients with severe pancreatic insufficiency treated with PE. This method might provide a useful means of assessing the availability of PEs at their site of action, in the absence of a PPL-specific ELISA.

Esomeprazole as a prophylactic agent for acid aspiration syndrome in adult patients undergoing elective surgery: A triple blind placebo controlled clinical trial

Background: To explore the effect of single oral dose of esomeprazole 20 mg, administered a night before surgery, on intragastric pH and volume in adult patients undergoing elective surgery by excluding cases contaminated with duodenogastric refluxate. Patients and Methods: This prospective, triple blind, randomised and placebo controlled clinical trial was conducted to explore the effect of single oral dose of esomeprazole 20 mg, administered a night before surgery, on intragastric pH and volume on 120 adult inpatients of either sex, American Society of Anaesthesiologist physical status I-II, and aged 15‐70 years. The patients in Group C (control) received placebo while Group E (Esomeprazole) received esomeprazole orally at 9.00 pm, the night before elective surgery. On the day of surgery, the gastric contents were aspirated with a large bore, multi-orifice gastric tube passed through an endotracheal tube placed blindly in the oesophagus after tracheal intubation and analysed for pH, volume and the presence of bile salts. Results: Thirty nine samples (33%) out of 117 were contaminated with duodenal contents. Duodenogastric reflux significantly affected pH and volume in Group C (p value 0.0003 and 0.0016) and E (p value 0.0401 and 25 ml/kg) at the time of induction of anaesthesia excluding samples contaminated with duodenogastric reflux.

Detection of endogenous DNA adducts, O6‐carboxymethyl‐2′‐deoxyguanosine and 3‐ethanesulfonic acid‐2′‐deoxycytidine, in the rat stomach after duodenal reflux

The endogenous DNA adducts O(6)-carboxymethyl-deoxyguanosine (O(6)-CM-dG) and 3-ethanesulfonic acid-deoxycytidine (3-ESA-dC) are produced from N-nitroso bile acid conjugates, such as N-nitrosoglycocholic acid (NO-GCA) and N-nitrosotaurocholic acid (NO-TCA), respectively. Formation of these DNA adducts in vivo was here analyzed by 32P-postlabeling in the glandular stomach of rats subjected to duodenal content reflux surgery. In this model, all duodenal contents, including bile acid conjugates, flow back from the jejunum into the gastric corpus. The levels of O(6)-CM-dG found at 4 and 8 weeks after surgery were 40.9 +/- 9.4 and 56.3 +/- 3.2 per 10(8) nucleotides, respectively, whereas the sham operation groups had values of 5.8 +/- 2.3 and 5.9 +/- 0.5 per 10(8) nucleotides. Moreover, adduct spots corresponding to 3-ESA-dC were detected in both duodenal reflux and sham operation groups and levels in the duodenal reflux groups were around four-fold elevated at 11.2 +/- 1.0 and 8.9 +/- 1.0 per 10(8) nucleotides after 4 and 8 weeks, respectively. When the duodenal reflux animals were treated with a nitrite trapping agent, thiazolidine- 4-carboxylic acid (thioproline, TPRO), the levels of O(6)-CM-dG and 3-ESA-dC were reduced to the same levels as in the sham operation animals. These observations suggest that NO-TCA and NO-GCA are formed by nitrosation of glycocholic acid and taurocholic acid, respectively, and these nitroso compounds produce DNA adducts in the glandular stomach of rats subjected to duodenal content reflux surgery.

Secretory phospholipase A 2 is required to produce histologic changes associated with gastroduodenal reflux in a murine model

The earliest response of esophageal mucosa to gastric reflux is the development of oxidative damage and inflammation. These processes contribute to the development of metaplasia known as Barrett's esophagus, as well as the progression to malignancy. Secretory phospholipase A(2) is a mediator of inflammation with levels that are increased in Barrett's metaplasia and carcinoma when compared with levels in normal samples. Our goal is to determine the role of secretory phospholipase A(2) in the development of reflux-associated changes in the esophageal mucosa. Secretory phospholipase A(2)-deficient mice (C57BL/6, n = 5) and mice known to express high levels of secretory phospholipase A(2) (BALB/c, n = 5) underwent side-to-side surgical anastomosis of the first portion of the duodenum and gastroesophageal junction, allowing exposure of esophageal mucosa to duodenal and gastric contents duodeno-gastroesophageal anastomosis. Control animals (n = 5) of each strain underwent laparotomy with esophagotomy and repair. Tissue was frozen in embedding medium. Hematoxylin and eosin staining and Ki67 and secretory phospholipase A(2) immunohistochemistry were used to evaluate esophageal tissue and its response to duodeno-gastroesophageal anastomosis. Immunofluorescent staining confirmed the absence of secretory phospholipase A(2) in C57BL/6 mice and its presence in BALB/c mice. Hematoxylin and eosin staining demonstrated significant thickening of the esophageal mucosa in response to gastroesophageal reflux in the presence of secretory phospholipase A(2). Mice known to express high levels of secretory phospholipase A(2) also demonstrated increased numbers of proliferating cells. Secretory phospholipase A(2)-deficient mice were immune to the early changes induced by mixed reflux. The presence of secretory phospholipase A(2) appears necessary for early histologic changes produced by exposure of the esophagus to gastroduodenal contents. This enzyme is identified as a promising target for evaluation of mechanisms of carcinogenesis and chemoprevention of esophageal carcinoma.

Avaliação da digestão ruminal, intestinal e total da matéria orgânica, proteína bruta e fibra em detergente neutro de rações com diferentes fontes de proteína utilizadas em bovinos

Three ruminant and duodenal fistulated steers (300 kg) were used in a 3x3 Latin square design to evaluate protein sources in the rations, on the ruminant, intestinal and total digestion of the organic matter (OM), crude protein (CP) and neutral detergent fiber (NDF). The treatments were composed of three rations with: urea (UR), feather meal (FEM) and corn gluten meal (CGM). The animals were fed daily at 8:00 am and 4:00 p.m. and, at the same time 5 g of Cr2O3 were introduced in the rumen. Periods lasted 14 days out of 11 days were used for adaptation to the ration and 3 days were used for the sample collection. During 72 hours duodenal contents and feces were collected, every 6 hours. The protein sources did not influence (p > 0.05) the OM intake or the partial/total digestibility. Among the treatments there were differences (p < 0.05) in the CP intake. The CGM treatment had a higher (p < 0.05) duodenal flow protein. The FEM treatment had CP the smallest (p < 0.05) total digestibility (g/day). Although, there were differences in the fiber intake, the ruminant and total (%) digestibility were not influenced (p > 0.05) by the treatments. Despite the protein sources used for this evaluation presented degradation differences, there were not effects in total digestibility for OM, CP and NDF.

Biliary parasites: Diagnostic and therapeutic strategies

Parasitic infections of the biliary tract are a common cause of biliary obstruction in endemic areas. This article focuses on primary biliary parasites: Ascaris lumbricoides, Clonorchis sinensis, Opisthorchis viverrini, Opisthorchis felineus, Dicrocoelium dendriticum, Fasciola hepatica, and Fasciola gigantica. Tropical and subtropical countries have the highest incidence and prevalence of these infections. Diagnosis is made primarily through direct microscopic examination of eggs in the stool, duodenal, or bile contents. Radiologic imaging may show intrahepatic ductal dilatation, whereas endoscopic retrograde cholangiopancreatography can be used diagnostically and therapeutically. However, oral treatment is inexpensive and effective for most of these parasites and can prevent untoward consequences. Primary and alternative treatments are available and are reviewed in this article.

Pre-anaesthetic oral lansoprazole for the prophylaxis of Mendelson′s syndrome and impact of duodenogastric reflux on pH and volume of gastric contents

Background. Lansoprazole, a proton pump inhibitor, is used in peptic ulcers and other acid dy speptic disorders. The aim of this study is to determine whether a single oral dose of lansoprazole 30 mg, administered a night before surgery , is effective on pH and volume of gastric contents after excluding those samples contaminated with duodenogastric refluxate (DGR). Patients and Methods. This clinical trial was conducted in 112 adult patients of both sex, ASA phy sical status I-II, and aged 15-70 y r. The patients in group C (control) received placebo while group L (lansoprazole 30 mg) orally at 9.00 p.m., a night before elective surgery . On the next day , gastric contents were aspirated with a large bore, multi-orifices gastric tube passed through an endotracheal tube placed blindly in esophagus after tracheal intubation and analy zed for the presence of bile salts, pH and volume. Results. Thirty three samples (30 %) out of 110 were contaminated with duodenal contents. DGR significantly affected the pH and volume in both the groups. Lansoprazole, after excluding those samples contaminated either with duodenal fluid or blood, significantly increased pH (P<0.0001), decreased volume (P=0.0326) and the proportion of the patients (10.52 % versus 30.76%) considered” at risk” compared with Placebo (P=0.0475) according to the criteria defined (pH ≤ 2.5 and volume ≥ 25 ml). Conclusions. Lansoprazole 30 mg given orally at 9.00 p.m., a night before surgery , significantly decreased the number of patients at risk of aspiration pneumonitis at the time of induction of anesthesia if the aspiration of gastric contents occurs.

The Irritable Infection

The Irritable Infection

Role of multispecies microbial biofilms in the occlusion of biliary stents

Endoscopic stenting is a standard palliative approach for the treatment of a variety of diseases involving biliary obstruction. However, the major limitation of this approach is represented by stent occlusion followed by life-threatening cholangitis, often requiring stent removal and replacement with a new one. Although it is generally believed that microbial colonization of the inner surface of the stent plays an important role in initiating the clogging process, so far available data are not enough for a full understanding of this phenomenon. In fact, it is known that when a biliary stent is inserted across the sphincter of Oddi, the loss of the antimicrobial barrier represented by the sphincter itself and the low pressure in the common bile duct allow reflux of duodenal content, thus promoting an ascending microbial colonization. The sessile mode of growth and the exopolysaccharide production, which leads to the subsequent establishment of a thick biofilm, provides microorganisms with an efficient protection from both antibacterial agents and phagocytic cells. The aim of this study was to analyze the tridimensional structure of the microbial biofilm grown in the lumen of 15 clogged biliary stents and to identify the microbial species involved in the clogging process. Scanning electron microscopy investigations revealed that sludge present in the stent lumen consist of a rich and assorted microbial flora, including aerobic and anaerobic species, mixed with a large amount of amorphous material containing dietary fibres, crystals of cholesterol and other precipitates of bacteria-driven bile salts. Key words: biliary stent, biofilm, microbial colonization, stent occlusion

Assessment of duodenal circular drainage in treatment of superior mesenteric artery syndrome

To assess the clinical value of duodenal circular drainage for superior mesenteric artery syndrome (SMAS). Forty-seven cases of SMAS were treated with duodenal circular drainage from 1959 to 2001. Clinical data were analyzed retrospectively. In this group, good effects were achieved in 39 cases treated with duodenal circular drainage after 2-15 years of follow-up. The other eight cases were first treated with anterior repositioning of the duodenum (two cases), duodenojejunostomy (five cases), subtotal gastrectomy and billroth II gastrojejunostomy (one case), but vomiting was not relieved until duodenal circular drainage was performed again. A follow-up study of 8-10 years revealed satisfactory results in these eight patients. In SMAS, if the reversed peristalsis is strong and continuous, and vomiting occurs frequently, the symptom can not be relieved even if the obstruction of duodenum is removed surgically. The key treatment is the relief of reversed peristalsis. The duodenal circular drainage can resolve the drainage direction of duodenal content, thus relieving the symptom of vomiting.

In vitro comparative study of three pancreatic enzyme preparations: dissolution profiles, active enzyme release and acid stability

Various pancreatic enzyme preparations are used for the treatment of pancreatic insufficiency but their bioequivalence is often unknown. To determine in vitro the pH-dependent release and acid resistance of enzymes from three commercially available pancreatin capsules, two containing enteric-coated (Creon 25000; Eurobiol 25000) and one uncoated (Eurobiol 12500) microspheres. Dissolution experiments were performed at pH values ranging from 4.0 to 5.8. Lipase, chymotrypsin and amylase activities were measured in the solution as a function of time. Eurobiol 25000 started to release its enzymes significantly at pH 5.0 (t(1/2) = 71 min), whereas the enzymes from Creon 25000 were only released at higher pH value (5.4; t(1/2) = 49.2 min). Unlike chymotrypsin, lipase and amylase were highly sensitive to acidic conditions at the lowest pH values tested. Both enzymes were also found to be sensitive to proteolytic inactivation at the highest pH values tested. Overall, Eurobiol 25000 released higher amounts of active amylase and lipase than Creon 25000 at the pH values usually found in duodenal contents. The uncoated Eurobiol 12500 preparation was, however, the only one that could immediately release rather high levels of active chymotrypsin and lipase at low pH (4.5). These findings suggest that pH-sensitive enteric-coated pancreatin products containing similar amounts of enzymes might not be bioequivalent depending on the pH of duodenal contents.

Vaccine Impedes the Development of Reflux-Induced Esophageal Cancer in a Surgical Rat Model: Efficacy of the Vaccine in a Pre-Barrett’s Esophagus Setting

Background & AimsWe developed a granulocyte-macrophage-colony-stimulating factor (GM-CSF) tumor vaccine for esophageal cancer. We evaluated the effectiveness of the vaccine as a prevention option in a surgical reflux rat model of esophageal cancer. MethodsA surgical model involving a jejuno-esophagostomy was used to create Barrett’s esophagus and esophageal cancer in rats. No carcinogen exposure was utilized. Cell lines derived from these tumors were stably passaged in vitro. GM-CSF-secreting tumor cells were generated using stable transfection. All rats underwent a total gastrectomy, followed by a jejuno-esophagostomy. The surgery promoted the reflux of duodenal contents into the esophagus. All animals were administered either a GM-CSF secreting whole cell vaccine or a phosphate-buffered saline (PBS) placebo injection 4, 6, 14, and 16 weeks post-surgery. ResultsWhile 15 of 16 animals in the non-vaccinated placebo group developed esophageal cancer, 94% (15 of 16), animals in the vaccine group had an incidence of cancer of 25% (4 of 16) (p < 0.05). Barrett’s esophagus was seen in 100% (16 of 16) of the controls and 83% (13 of 16) of the vaccinated animals. ConclusionsA GM-CSF-secreting whole cell tumor vaccine impeded esophageal tumor growth, but not the development of Barrett’s esophagus, in a clinically relevant surgical reflux model.

High Serum Bile Acids Cause Hyperthyroidism and Goiter

In the duodenal content reflux model of rats, we noted an elevation of serum bile acid and swelling of the thyroid gland. This study was designed to elucidate whether bile acids (BAs) also enhance thyroid function. In varying lengths of period after esophago-jejunostomy without gastrectomy, which causes duodenal content reflux, rats were sacrificed and blood samples were taken from the heart for analyses of BAs and triiodothyronine (T3), thyroxine (T4), free T3 (fT3), free T4 (fT4), and thyroid-stimulating hormone (TSH) in the serum. Macroscopically, at 10 and 30 weeks after operation, thyroid glands in the reflux model showed a symmetric enlargement because of the presence of diffuse hypertrophy of the thyroid follicular epithelium. At both time points, no significant differences were detected in T3, T4, fT3, and fT4 levels between the reflux model and the control group, whereas, at 10 weeks after operation, the animals with the reflux showed significantly lower serum TSH levels and greater thyroid weight than those in the control group. An inverse correlation between serum BAs and TSH levels was noted in the reflux model but not in the control group. Microscopically, thyroid follicles were greater in size and number, with paler colloids in the reflux model than the control group. The present results suggest that high serum BAs cause hyperplasia of the thyroid follicles and the reduction of TSH. The effects of BAs on thyroid hormones, thus, include the induction of overall hyperthyroidism. Therefore, the strict monitoring of serum TSH levels is of vital importance if BAs are used for the treatment of obesity.

High animal‐fat intake changes the bile‐acid composition of bile juice and enhances the development of Barrett's esophagus and esophageal adenocarcinoma in a rat duodenal‐contents reflux model

The dietary components responsible for the development of Barrett's esophagus (BE) and esophageal adenocarcinoma (EAC) remain unclear. Wistar rats were divided into four groups based on their diet: a low soybean-oil diet, a low cow-fat diet, a high soybean-oil diet, and a high cow-fat diet. First, we evaluated the bile acid composition of the bile juice in each group without operation, using high-performance liquid chromatography. Because only high cow-fat intake induced changes in the composition of bile acids in bile juice, we then selected animals fed with a low soybean-oil diet and those with a high cow-fat diet to carry out esophago-jejunostomy for reflux of the duodenal contents, and compared sequential morphological changes between these groups up to 30 weeks after surgery. At 30 weeks after surgery, the reflux animals in the high cow-fat group showed a significantly higher incidence of BE and Barrett's dysplasia than those in the low soybean-oil group, and the incidence of EAC in the high cow-fat group was also slightly higher than that in the low soybean-oil group. High dietary animal fat changed the bile-acid composition and increased the concentration of taurine conjugates in the bile juice. These increased bile acids promoted the development of BE and Barrett's dysplasia leading to EAC.

Duodenal Contents Reflux-Induced Laryngitis in Rats: Possible Mechanism of Enhancement of the Causative Factors in Laryngeal Carcinogenesis

The main factors considered responsible for the onset of laryngeal cancer are tobacco smoking and alcohol abuse. Recently, gastroesophageal reflux has also been implicated as a causative factor in several laryngeal disorders, including laryngeal cancer. However, the significance of gastroesophageal reflux in laryngeal cancer is controversial. We investigated the histologic features of the esophagus and larynx in a rat model of reflux of the duodenal contents. Cell proliferation was also evaluated in laryngeal samples by detection of Ki67 antigen. In this reflux model, laryngitis with infiltration of inflammatory cells and proliferation of small mucous glands was evident from 10 weeks after operation, and basal cell hyperplasia around the epiglottis and hyperplastic changes in the larynx were detected at 30 weeks. No dysplastic or malignant lesions were detected in the laryngeal samples within the duration of the experiment, in spite of detection of malignancy in 31.3% of lesions in esophageal samples at 30 weeks. The Ki67 index at each week was significantly higher than that of the control animals. Previous studies have shown smoking and alcohol abuse to have refluxogenic effects. Reflux of duodenal contents causes laryngitis. Reflux does not appear to be an independent risk factor for laryngeal carcinogenesis, but it may enhance the acknowledged etiologic risk factors, namely, smoking and alcohol abuse, by promoting cell proliferation.

The effect of tripotassium dicitrato bismuthate on the rat stomach.

Bismuth has been used as symptomatic treatment of dyspepsia for many years. It promotes healing of peptic ulcers and reduces their recurrence. The beneficial effect of bismuth on duodenal ulcer disease is thought to be due to an effect on Helicobacter pylori, although it has a rather weak bactericidal effect on H. pylori in vitro. Eradication of H. pylori in duodenal ulcer patients by a combination of bismuth, tetracycline and metronidazole has been reported to increase the density of somatostatin-producing D cells in the antrum. A reduced D cell density in the antral mucosa of duodenal ulcer patients could explain their exaggerated gastrin release. To test the possibility that bismuth could affect the neuroendocrine cells independently of the presence of H. pylori or not, we gave rats a diluted tripotassium dicitrato bismuthate solution by gastric gavage for 14 days. Tripotassium dicitrato bismuthate treatment did not affect maximal pentagastrin-stimulated acid secretion or histamine release in isolated rat stomachs or the density of argyrophil cells in the oxyntic and antral mucosa. However, it significantly reduced the duodenal concentration of gastrin and calcitonin gene-related peptide, and the density of G cells in the antrum and duodenum. The effect of tripotassium dicitrato bismuthate on the G cell may be of significance for its beneficial effect on duodenal ulcer disease.

A Rat Surgical Model of Esophageal Metaplasia and Adenocarcinoma-Induced by Mixed Reflux of Gastric Acid and Duodenal Contents

Recent clinical data have revealed that mixed reflux (MR) of gastric acid and duodenal contents frequently occurs in patients with gastroesophageal reflux disease and a progressive increase of MR occurs with increasing severity across gastroesophageal reflux disease. Herein we report a novel rat surgical model in which esophageal metaplasia and adenocarcinoma develop as complications of MR. The model was created by performing an esophagojejunostomy and a gastrojejunostomy 5 mm proximal to the esophagojejunal anastomosis in 40 rats. Severe inflammatory and proliferative changes, high prevalence of esophageal metaplasia (78%), and adenocarcinoma (50%) were observed in the lower part of the esophagus of rats 20 weeks after surgery. The resulting esophageal lesions resembled those described in humans and supported a progression from intestinal metaplasia to dysplasia and, ultimately, esophageal adenocarcinoma. Such a model may provide a useful tool in study of human reflux-induced carcinogenesis.

What Is the Difference between Proximal and Total Gastrectomy Regarding Postoperative Bile Reflux into the Oesophagus?

Background: Tumours of the oesophagogastric junction and the gastric cardia can be treated either with proximal or with total gastrectomy. Reflux of bile and other duodenal contents into the oesophagus following proximal gastrectomy has generally been considered worse than reflux after total gastrectomy. The aim of the present study was to test this assumption given that there is limited literature regarding objective evaluation of the postoperative duodeno-oesophageal reflux. Patients and Methods: We carried out bilirubin monitoring with the ambulatory spectrophotometer Bilitec 2000 in two groups of patients and in one group of healthy volunteers matched in age and sex. The proximal gastrectomy group consisted of 8 patients who underwent proximal gastrectomy and an end-to-side oesophagogastrostomy without pyloric drainage procedure. The total gastrectomy group consisted of 11 patients who underwent total gastrectomy and Roux-en-Y reconstruction with a 50-cm-long jejunal limb. The control group consisted of 8 healthy volunteers. In all cases, an absorption value of 0.14 was used as the threshold for reflux episodes. Results: The median fraction of time that bilirubin absorbance was >0.14 in the proximal versus total gastrectomy group was 47.4 and 13.4%, respectively (p = 0.02). The difference between the two groups was significant in the supine position (p = 0.03), whilst the upright position, meal and postprandial periods were not found to have significant difference. Likewise, no significant difference was found in the number of reflux episodes. The median fraction of time in the proximal gastrectomy group compared with controls was 47.4 versus 3.95% (p < 0.001), whilst in the total gastrectomy group compared with controls, itwas 13.4 versus 3.95% (p > 0.05). The number of reflux episodes in the proximal gastrectomy group compared with controls was 74 versus 21 (p = 0.02), whilst in the total gastrectomy group compared with controls, it was 103 versus 21 (p > 0.05). Conclusions: Total gastrectomy with Roux-en-Y reconstruction reduces the time of oesophageal exposure to duodenal juices as compared with proximal gastrectomy. This effect seems to be more prominent in the supine position.

"Effect of single oral dose of Sodium Rabeprazole administered a night before surgery on the intragastric pH and volume in adult patients undergoing elective surgery" a triple blind placebo controlled clinical trial

Back Ground: Saliva, duodenogastric refluxate and blood due to gastric mucosal entrapment can affect both pH and volume of gastric contents while sampling from stomach. This issue has never been exposed while evaluating the effectiveness of drugs used for the prophylaxis of acid aspiration. We considered all these factors. Methods: This prospective, triple blind, randomized and placebo controlled clinical trial was conducted to explore the effect of single oral dose of Sodium Rabeprazole 20 mg on intragastric pH and volume in 100 adult inpatients of either sex, ASA I-III, and aged 15-70 years. The patients in Group S received (Sodium Rabeprazole 20 mg) while Group C received Placebo orally at 9.00 p.m., a night before elective surgery. Gastric contents were aspirated with a large bore, multi-orifices gastric tube passed through an endotracheal tube placed blindly in esophagus after tracheal intubation and analyzed for the presence of bile salts, pH and volume. Results: Fifteen cases (15.15%) were contaminated with duodenal contents and one with blood (1%). The proportion of the patients considered at risk according to the criteria defined (pH ≤ 2.5 and volume ≥ 25 ml) was statistical significant in Group S compared with Placebo (p value 0.0005). Conclusion: Oral Sodium Rabeprazole 20 mg administered a night before elective surgery does improve the gastric environment at the time of induction of anesthesia, should the aspiration of gastric contents occur.

Effect of saliva on PH and volume of gastric contents while sampling from stomach with two different techniques of orogastric intubation

Objectives: To explore the effect of saliva on pH and volume of gastric aspirate by using two different techniques of blind gastric aspiration of gastric contents. Materials and Methods: This prospective and randomized clinical trial was conducted in the Department of Anaesthesia at King Khalid University Hospital, Al-Riyadh, Saudi Arabia from August to December, 2006 on 140 adult inpatients of either sex, aged 15-70 years and American Society of Anesthesiologists physical status I-II. An orogastric tube was passed by conventional method in Group A and through an endotracheal tube placed in esophagus in Group B. Gastric contents were aspirated with a large bore, multi-orifices gastric tube after tracheal intubation and analyzed for the presence of bile salts, pH and volume. Results: Thirty nine (28.57 %) samples were contaminated with duodenal contents and one with blood. Six patients have no gastric contents in Group A due to failed orogastric intubation and none in Group B (p 0.0280). Saliva, by conventional method of orogastric intubation, significantly affected both the pH (A-2 versus B-2: p <0.0001) and volume (A-2 versus B-2: p 0.0045) of gastric contents. Duodenogastric refluxate significantly affected both the pH (A-1 versus A-2: p0.0236), B-1 versus B-2: p 0.0019) and volume (A-1 versus A-2: p .0343), B-1 versus B-2: p 0.0005) of gastric contents. Conclusion: Saliva significantly affected both the pH and volume of gastric contents when sampled by conventional method of orogastric intubation. Duodenogastric refluxate significantly affected both the pH and volume of gastric contents.