Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
Am J Gastroenterol. 2013 Jul;108(7):1058-64. doi: 10.1038/ajg.2013.132. Epub 2013 Apr 30.
The nadir esophageal pH of reflux observed during pH monitoring in the postprandial period is often more acidic than the concomitant intragastric pH. This paradox prompted the discovery of the "acid pocket", an area of unbuffered gastric acid that accumulates in the proximal stomach after meals and serves as the reservoir for acid reflux in healthy individuals and gastroesophageal reflux disease (GERD) patients. However, there are differentiating features between these populations in the size and position of the acid pocket, with GERD patients predisposed to upward migration of the proximal margin onto the esophageal mucosa, particularly when supine. This upward migration of acid, sometimes referred to as an "acid film", likely contributes to mucosal pathology in the region of the squamocolumnar junction. Furthermore, movement of the acid pocket itself to a supradiaphragmatic location with hiatus hernia increases the propensity for acid reflux by all conventional mechanisms. Consequently, the acid pocket is an attractive target for GERD therapy. It may be targeted in a global way with proton pump inhibitors that attenuate acid pocket development, or with alginate/antacid combinations that colocalize with the acid pocket and displace it distally, thereby demonstrating the potential for selective targeting of the acid pocket in GERD.
在餐后 pH 监测中观察到的食管 pH 最低点反流通常比同时的胃内 pH 更酸。这种矛盾现象促使人们发现了“酸口袋”，这是一个在餐后积聚在胃近端的无缓冲胃酸区域，是健康人和胃食管反流病（GERD）患者胃酸反流的储库。然而，在酸口袋的大小和位置上，这些人群之间存在区别，GERD 患者易向上迁移近端边缘到食管黏膜，尤其是仰卧位时。这种向上迁移的酸，有时被称为“酸膜”，可能导致鳞柱状交界处区域的黏膜病理。此外，酸口袋本身通过膈疝移动到膈上位置，通过所有常规机制增加胃酸反流的倾向。因此，酸口袋是 GERD 治疗的一个有吸引力的靶点。它可以通过质子泵抑制剂来进行全面的靶向治疗，这些抑制剂可以减弱酸口袋的发展，或者通过藻酸盐/抗酸剂的组合来靶向酸口袋，并将其推向远端，从而证明在 GERD 中靶向酸口袋的选择性治疗的潜力。
