Skip to main content
SpringerLink
Log in

Influence of exocrine pancreatic insufficiency on the intraluminal pH of the proximal small intestine

  • Original Articles
  • Published:
Digestive Diseases and Sciences Aims and scope Submit manuscript

Abstract

The effect of significant exocrine pancreatic disease on the intraluminal pH in the upper small intestine was studied in seven patients with pancreatic insufficiency (PI) and seven control subjects. A cecar microelectrode (Beckman) attached to a polyvinyl tube was positioned at the ligament of Treitz under fluoroscopic control and the output of the pH meter was recorded for 30 minutes under fasting conditions after an equilibration period. Analysis of the pH tracing revealed a significantly lower mean intraluminal pH in PI patients as compared to the control subjects (PI vs controls: mean±sem, 6.1±0.2 vs 7.0 ±0.2, P<0.01). The acid fluctuations per ten-minute period of time were more frequent and the percent time below pH 4.0 was significantly higher in this group of patients (P< 0.05). The basal and the stimulated gastric acid outputs were lower in PI patients. However, the difference did not reach statistical significance. In two PI patients and two control subjects, the intraluminal pH at the duodenojejunal junction was further recorded for 180 minutes after the ingestion of a standardized test meal. Intraluminal pH dropped below 4.0 in both PI patients and continued in that range until the end of the study. However, in the two control subjects, the intraluminal pH stayed well above pH 4.0 during the entire postprandial period. Furthermore, a definite rise with a trend towards the fasting intraluminal pH was also observed. These data indicate that patients with significant exocrine pancreatic disease have an acidic milieu in the upper small intestine both under fasting as well as under postprandial conditions. The clinical relevance of this observation is discussed.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Rune SJ: pH in the human duodenum. Digestion 8:261–268, 1973

    PubMed  Google Scholar 

  2. Winship DH, Robinson JE: Acid loss in the human duodenum: Volume change, osmolal loss and CO2 production in response to acid loss. Gastroenterology 66:181–188, 1974

    PubMed  Google Scholar 

  3. Bayliss WM, Starling EH: The mechanism of pancreatic secretion. J Physiol 28:325–453, 1902

    Google Scholar 

  4. Rutherford W: A report on biliary secretion of the dog with reference to the action of cholagogues. Br Med J 1:177–189, 1897

    Google Scholar 

  5. Florey HW, Harding HE: The nature of hormone controlling Brunner's glands. Q J Exp Physiol 25:329–339, 1935

    Google Scholar 

  6. Wormsley KG: Reaction to acid in the intestine in health and disease. Gut 12:67–84, 1971

    PubMed  Google Scholar 

  7. Pincus IJ, Thomas JE, Hauman D, Lachman PO: Relationship between the pH of the duodenal content and pancreatic secretion. Soc Exp Biol Med 67:497–501, 1948 (Proceedings)

    Google Scholar 

  8. Brooks FP: Pancreatic Secretion in Control of Gastrointestinal Function. London, MacMillan Company, Ltd., 1970, pp 58–78

    Google Scholar 

  9. Snedecor GW: Statistical Methods. 5th Ed. Ames, Iowa, Iowa State University Press, 1956

    Google Scholar 

  10. DiMagno EP, Go VLW, Summerskill WHJ: Relations between pancreatic enzyme outputs and malabsorption in severe pancreatic insufficiency. N Engl J Med 288:813–815, 1973

    PubMed  Google Scholar 

  11. Benn A, Cook WT: Intraluminal pH of duodenum and jejunum in fasting subjects with normal and abnormal gastric and pancreatic function. Scand J Gastroenterol 6:313–317, 1971

    PubMed  Google Scholar 

  12. Worning H, Mullertz S, Taysen HE, Bang HO: pH and concentration of pancreatic enzyme in aspirates from the human duodenum during digestion of a standard meal in patients with pancreatic diseases. Scand J Gastroenterol 2:90–93, 1967

    Google Scholar 

  13. Bircher J, Mann CV, Carlson HC, Code CF, Rovestad RA: Intraluminal and juxtamucosal duodenal pH. Gastroenterology 48:472–477, 1965

    PubMed  Google Scholar 

  14. Rune SJ: An electrode for pH measurement in the gastrointestinal tract. Scand J Gastroenterol 3:91–94, 1968

    PubMed  Google Scholar 

  15. Bank S, Marks IN, Groll A: Gastric acid secretion in pancreatic disease. Digestion 51:649–655, 1966

    Google Scholar 

  16. Gupta S, Rao TRG: Gastric acid secretion in pancreatic disease. Digestion 12:189–191, 1975

    PubMed  Google Scholar 

  17. Worning H, Mullertz S: pH and pancreatic enzymes in the human duodenum during digestion of a standard meal. Scand J Gastroenterol 1:268–283, 1966

    PubMed  Google Scholar 

  18. Greenlee HB, Nelson T, Dragstedt LR: The effect of pancreatic fistula on gastric secretion. Arch Surg 79:1004–1008, 1959

    PubMed  Google Scholar 

  19. Greenlee HB, Johnson AN, Nelsen TS, Dragstedt LR: Total pancreatic duct ligation: Effect on gastric secretions. Arch Surg 83:872–877, 1961

    PubMed  Google Scholar 

  20. Dutta SK, Russell RM, Iber FL: Impaired acid neutralization in the duodenum in pancreatic insufficiency. Dig Dis Sci (in press)

  21. Long WB, Weiss JB: Rapid gastric emptying of fatty meals in pancreatic insufficiency. Gastroenterology 67:920–925, 1974

    PubMed  Google Scholar 

  22. Fiddian-Green RG, Silen W: Mechanisms of disposal of acid and alkali in rabbit duodenum. Am J Physiol 229:1641–1648, 1975

    PubMed  Google Scholar 

  23. DiMagno EP, Malagelada JR, Go VLW, Moertel CG: Fate of orally ingested enzymes in pancreatic insufficiency. N Engl J Med 296:1318–1322, 1977

    PubMed  Google Scholar 

  24. Heizer WD, Cleveland CR, Iber FL: Gastric inactivation of pancreatic supplements. Bull Johns Hopkins Hosp 116:261–270, 1965

    PubMed  Google Scholar 

  25. Regan PT, Malagelada JR, DiMagno EP, Glanzman SL, Go VLW: Comparative effects of antacids, cimetidine and enteric coating on the therapeutic response to oral enzymes in severe pancreatic insufficiency. N Engl J Med 297:854–858, 1977

    PubMed  Google Scholar 

  26. Borgstrom B: Partition of lipids between emulsified oil and micellar phases of glyceride bile salt dispersions. J Lipid Res 8:598–608, 1967

    PubMed  Google Scholar 

  27. Dietschy JM: Mechanisms for the intestinal absorption of bile acids. J Lipid Res 9:297–309, 1968

    PubMed  Google Scholar 

  28. Weber AM, Roy CC, Chartrand L, et al: Relationship between bile acid malabsorption and pancreatic insufficency in cystic fibrosis. Gut 17:295–299, 1976

    PubMed  Google Scholar 

  29. Russell RM, Chang H, Rosenberg IH: Enhanced folic acid absorption in pancreatic insufficiency: Assessment of folate binding capacity of pancreatic proteins. Gastroenterology 66:873, 1974

    Google Scholar 

  30. Blair JA, Matty AJ: Acid microclimate in intestinal absorption. Clin Gastroenterol 3:183–197, 1974

    PubMed  Google Scholar 

  31. White TT, Murat J, Morgan A: Pancreatitis related to trauma, duodenal eulcer and surgery. Northwest Med 67:557–560, 1968

    PubMed  Google Scholar 

  32. Warren KW: Pathologic considerations as a guide to the choice of surgical procedures in the management of chronic relapsing pancreatitis. Gastroenterology 36:224–231, 1959

    PubMed  Google Scholar 

  33. Howard JM, Jordan GL: Surgical Diseases of the Pancreas. London, Pitman Medical Publishing, 1960, p 211

    Google Scholar 

  34. Rune SJ: pH in the human duodenum. Digestion 8:261–268, 1973

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Medicine, Division of Gastroenterology, Veterans Administration Medical Center, (151), 3900 Loch Raven Boulevard, 21218, Baltimore, Maryland

    Sudhir K. Dutta MD, Robert M. Russell MD & Frank L. Iber MD

  2. University of Maryland School of Medicine, (151), 3900 Loch Raven Boulevard, 21218, Baltimore, Maryland

    Sudhir K. Dutta MD, Robert M. Russell MD & Frank L. Iber MD

Authors
  1. Sudhir K. Dutta MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Robert M. Russell MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Frank L. Iber MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Additional information

This study was supported in part by the Medical Research Service of the Veterans Administration.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Dutta, S.K., Russell, R.M. & Iber, F.L. Influence of exocrine pancreatic insufficiency on the intraluminal pH of the proximal small intestine. Digest Dis Sci 24, 529–534 (1979). https://doi.org/10.1007/BF01489321

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF01489321

Keywords

Search

Navigation