pH-metry of the stomach

The health of the gastrointestinal tract is the key to well-being and longevity. It is from the state of the gastrointestinal tract and normal digestion depends on the metabolic rate.

The main indicator of the normal functioning of the stomach is its acidity. This is the name of the indicator of the concentration of hydrogen ions in gastric juice, which is denoted in conventional units of pH.

The main component of gastric juice is hydrochloric acid. It is necessary mainly for the breakdown of protein products that enter the stomach, the nutrients from which will then be absorbed in the small intestine. In addition, it is thanks to hydrochloric acid that the conditions necessary for the absorption of iron from food and the work of digestive enzymes are created. Equally important is also associated with the antibacterial properties of hydrochloric acid.

It should be taken into account that the concentration of hydrochloric acid in the stomach of a person who does not have problems with the health of the digestive system is constant. It is 160 mmol / l. However, in addition to acid, the composition of gastric juice also includes alkaline components.

If the ratio of these two substances is disturbed, the acidity of the stomach either decreases or increases. The reason for this may be an unbalanced and irregular diet, bad habits, alcohol abuse, taking certain medications, as well as stress.

Both low and high acidity is a pathological condition that not only provokes unpleasant symptoms, but also causes malfunctions in the entire digestive tract. It is the increase in acidity that causes ulcerative disease, gastritis, duodenitis, gastroesophageal reflux disease (GERD), etc. In turn, low acidity can be accompanied by such phenomena as increased gas formation and flatulence, a tendency to constipation, intestinal colic, decreased appetite, and belching with a characteristic sulfuric odor.

Thus, the acidity index must be regularly monitored, since any deviations from the norm can become a “trigger” that triggers serious malfunctions in the entire digestive system. Therefore, it is very important to recognize the first symptoms of an acid disorder and take action.

How to study the acidity of gastric juice

There are several methods to determine the acidity of the stomach. So, fractional sounding can be carried out, during which part of the contents of the stomach is sucked off using a special tube, and then examined in the laboratory. This method is considered not very reliable, since the very process of such a diagnosis, which is long and rather unpleasant for the patient, disrupts the natural functioning of the stomach, as a result of which the results obtained are only partially credible.

Another method is called “staining of the stomach wall.” Its essence is that a special dye is introduced through the endoscope channel during the gastroscopy procedure. The doctor then monitors how the color of the dye changes, on the basis of which he draws conclusions about the acidity.

Experts are also wary of this method, since it is based solely on visual data and gives only very approximate results.

Quite uninformative, although not traumatic for the patient, is the method of studying acidity using ion-exchange resins. The patient is asked to take a special reagent, which includes a pigment. This dye passes through the gastrointestinal tract, and then excreted in the urine. Assessing the degree of staining of urine, doctors draw a conclusion about the acidity of the stomach.

Finally, there is another, the most informative method that allows you to obtain accurate data on the concentration of acid in the stomach. This is pH-metry, which includes the measurement of acidity in different areas of the gastrointestinal tract for a certain time. For this, special devices are used – acid gastrometers, which are equipped with several pH sensors attached to the probes.

Indications for pH-metry

First of all, it should be remembered that you cannot “assign” this procedure to yourself. Only a gastroenterologist directs for examination – in the event that he believes that problems in the digestive tract may be associated with a violation of acidity. There are also diseases in which this study is indicated. This is a peptic ulcer, chronic gastritis and duodenitis, pancreatic adenoma, changes in the tissues of the epithelium of the esophageal mucosa, as well as GERD.

In addition, the doctor may prescribe pH-metry to monitor the patient’s condition after gastric resection, as well as to control the effect of drugs designed to reduce or increase the acidity of gastric juice.

Finally, this diagnostic method is indicated if it is not possible to accurately establish the etiology of the disease and there are doubts about the correctness of the therapy.

Types of pH-metry

To date, there are several types of pH-metry that allow solving various diagnostic problems.

The simplest method is endoscopic pH-metry. This procedure takes only about five minutes. It is carried out during fibrogastroscopy. A special pH probe is inserted into the instrumental channel of the endoscope, with the help of which the level of acidity is determined at nine points of the stomach and duodenum. The procedure is carried out under visual control. When interpreting the results, doctors take into account the fact that endoscopy itself stimulates the production of acid in the stomach.

Express examination, which takes at least half an hour. In this case, the acidity level is determined exclusively by the pH level in the so-called body of the stomach.

Short-term intragastric pH-metry. This procedure involves the determination of the initial indicators of the acidity of the stomach, as well as its stimulation with special substances. Doctors analyze the averages in different departments, on the basis of which they make a general conclusion.

Daily study, the duration of which is 24 hours. In this case, the patient is not all the time in the hospital or in the doctor’s office, but must continue his usual lifestyle and be in a familiar environment. The patient is asked to take food in the mode in which he is used to taking it, as well as to record his feelings and details of well-being in a special diary.

Which technique is used in each case depends primarily on the individual characteristics of the patient, as well as on the disease. All types of diagnostics, except for the daily one, are carried out in a hospital, patients are under the supervision of medical personnel.

Methodology and preparation for the study

As noted above, the devices that are used for pH-metry are called acid gastrometers. These are flexible probes equipped with special measuring electrodes that are inserted through the mouth or through the nose into certain sections of the gastrointestinal tract.

The probe is inserted exclusively in the morning, on an empty stomach. At the same time, at least twelve hours must pass from the last meal without fail. Smoking is also prohibited during this time. Please note that you can drink water for the last time no later than four hours before the procedure – otherwise, the risk of complications when inserting the probe increases (the patient will feel nausea, vomiting may occur). In addition, water can change the acidity of the stomach, which will distort the data of the study, as a result of which the reliability of the results will decrease.

Before diagnosing, you should inform your doctor about what medications you are taking. Some medications should be discontinued at least three days before the procedure, others should be discontinued twenty-four hours before the diagnosis.

It is recommended a few days before the procedure to stop taking products that can distort the data by changing the pH of the stomach. So, it is necessary to completely exclude black coffee, strong tea, fruit juices and yogurts from the diet, or at least reduce the presence of these products on the menu as much as possible. Alcohol and carbonated drinks, as well as mineral water, should be completely excluded.

Express and short-term pH-metry is carried out in a medical office, under the constant supervision of a doctor. The patient is in a sitting position. For these studies, oral pH probes are usually used – in other words, those that are administered through the mouth. Such probes are thicker than transnasal ones, but the risk that they wrap up in the stomach is an order of magnitude less.

The most frightening for many patients is the daily diagnosis. As a rule, people are alarmed by the fact that there will be no medical worker next to them, and the probe will be inside for a long time. A qualified doctor should be sympathetic to such experiences and explain in detail to the patient the essence of the procedure and his behavior during the study.

The probe for the daily study is inserted through the nasopharynx, so the patient will be able to eat as usual. The recorder is attached to the belt. To make these studies more accurate and complete, the patient is asked to keep records in a special diary. Most often, it is required to mark the time of eating and medication, as well as indicate periods of staying in a horizontal position. It is also necessary to record any negative sensations associated with the gastrointestinal tract – heartburn, nausea, discomfort. It is daily diagnostics that is considered the most informative and complete and provides the maximum amount of information necessary to analyze the patient’s condition.

Contraindications to the procedure

As with any medical manipulation, pH-metry has a rather impressive list of contraindications. Therefore, in the event that the doctor talks about the need for this diagnosis, it is necessary to clarify exactly what diseases you suffer from and what medications you take.

Contraindications to the study include not only diseases in which the insertion of a gastric tube is not recommended, but also health problems in which the use of certain bioactive stimulant substances is not allowed.

So, the pH probe is forbidden to enter during gastric bleeding, as well as for ten days after its termination. Patients with an aortic aneurysm, as well as those who have been diagnosed with coronary insufficiency and severe hypertension, should refrain from the procedure.

The probe must not be inserted for any injuries and burns of the esophageal mucosa, as well as for serious violations of blood clotting. The reason for the refusal of the procedure are also maxillofacial injuries and obstruction of the nasopharynx. Difficulties with the introduction of the probe may occur in patients suffering from thyroid diseases, in particular, nodular goiter.

The psychological factor is also of great importance. People with an overly labile nervous system are often simply unable to properly tune in to the procedure, as a result of which they may begin asthma attacks or panic attacks.

As a rule, such phenomena can be avoided if the doctor explains the essence of the manipulations.

Possible complications of the procedure

Complications during gastric pH monitoring are rare, but their possibility cannot be completely ruled out. So, there is a risk of injury to the nasopharynx, esophagus or gastric mucosa if the patient has been diagnosed with atrophic rhinitis, narrowing of the esophagus or dilatation of its veins. Anesthetic and substances that stimulate secretion can provoke individual intolerance in allergy sufferers.

In overly impressionable people, diagnosis can provoke a panic attack, asthma attacks, dizziness or fainting. As a rule, such phenomena are psychosomatic in nature. All these complications can be avoided if the doctor is able to find a common language with the patient and tells him in detail about the essence of the study, and the patient himself properly tunes in to the diagnosis.

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