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Lower Esophageal Sphincter Response to Gastric Alkalinization: A New Mechanism for Treatment of Heartburn with Antacids

Cdr. DONALD O. CASTELL; and Lt. Cdr. STEPHEN M. LEVINE
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▸Requests for reprints should be addressed to Donald O. Castell, M.D., U.S. Naval Hospital, Philadelphia, Pa. 19145


Ann Intern Med. 1971;74(2):223-227. doi:10.7326/0003-4819-74-2-223
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Recent studies have shown that the hormone gastrin has a profound effect on lower esophageal sphincter pressure. The present study was performed to evaluate the effect of different gastric alkalinizing agents. Sphincter pressure was monitored continuously in a group of normal subjects, using fluid-filled catheters. Instillation of 0.1 N hydrochloric acid into the stomachs of these subjects resulted in consistent decreases in lower esophageal sphincter pressure. The subsequent instillation of 0.1 N sodium bicarbonate resulted in striking increases in sphincter pressure to values much greater than basal levels. Similar results were obtained when 0.1 N sodium hydroxide or a commercial antacid preparation was placed into the stomach. Alkalinization of the stomach by various agents results in marked increases in lower esophageal sphincter pressure. The proposed mechanism of action is through release of endogenous gastrin from the antrum. Treatment of heartburn with alkali appears to have a dual effect—neutralization of gastric acid and an increase in the lower esophageal sphincter pressure barrier.

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