Chronic gastric ischemia. A cause of abdominal pain or bleeding identified from the presence of gastric mucosal acidosis.

Acidosis in gastric mucosa (pHi less than 7.32) was evaluated as a diagnostic test for gastric ischemia, using 80 asymptomatic subjects as controls. Mucosal acidosis was found in 6 patients with abdominal pain and 1 with gastrointestinal bleeding. Three had occlusive disease of 2 or more visceral arteries, 3 had occlusive disease of the celiac axis alone, and 1 had an occluded portal vein. One patient had infarcted gut. The abnormal pHi (7.10 +/- 0.11, mean +/- SD) in those with pain was returned to normal levels (7.43 +/- 0.08, p = 0.0003) and the symptoms relieved by revascularization. The abnormal pHi (6.84 +/- .04) in the patient who bled was restored to normal levels (7.48 +/- .03, t = 9.69, p less than .0001) and the bleeding stopped by a central splenorenal shunt. Measurements of pHi in gastrointestinal mucosa may be used as an objective test for evaluating patients suspected of having chronic gastrointestinal ischemia.