0

The full content of Annals is available to subscribers

Subscribe/Learn More  >
Articles |

Cigarette Smoking Inhibits Acid-Stimulated Duodenal Mucosal Bicarbonate Secretion

Mark A. Ainsworth, MD, PhD; Daniel L. Hogan, BA; Michael A. Koss, BS; and Jon I. Isenberg, MD
[+] Article and Author Information

From the University of California at San Diego Medical Center, California, and Odense University Hospital, Denmark. Requests for Reprints: Jon I. Isenberg, MD, Division of Gastroenterology, Department of Medicine, UCSD Medical Center, 225 Dickinson Street, San Diego, CA 92103-8413. Acknowledgments: The authors thank Dr. Mark Feldman for his comments on the manuscript. The authors also thank the late Dr. A. Robert (Upjohn; Kalamazoo, Michigan) for the gift of natural PGE2. Grant Support: By National Institutes of Health grant AM 33491 and by Forskerakademiet (Denmark).


Copyright 2004 by the American College of Physicians


Ann Intern Med. 1993;119(9):882-886. doi:10.7326/0003-4819-119-9-199311010-00003
Text Size: A A A

Objective: To determine the effect of cigarette smoking on proximal duodenal mucosal bicarbonate secretion, an important defense mechanism against acid and peptic damage.

Design: Prospective study.

Setting: Clinical research laboratory in a university hospital.

Patients: Thirteen healthy adults (7 smokers and 6 nonsmokers) who had no history of peptic ulcer disease.

Interventions: Participants smoked (1 cigarette/15 min during a period of 1 hour, smokers only) or sham smoked (puffing on an unlit cigarette) during duodenal perfusion with saline, hydrochloric acid, or prostaglandin E2 (PGE2).

Measurements: Collection of proximal duodenal secretions using a modified duodenal tube with occluding balloons and quantitation of duodenal mucosal bicarbonate secretion.

Results: During sham smoking both smokers and nonsmokers had comparable basal as well as H+-stimulated and PGE2-stimulated duodenal mucosal bicarbonate secretion. Compared with sham smoking, smoking did not significantly alter basal bicarbonate secretion (201 mol/cm per hour [95% CI, 152 to 250 mol/cm per hour] compared with 178 mol/cm per hour [CI, 134 to 222 mol/cm per hour], respectively). However, compared with sham smoking, smoking markedly reduced (P < 0.01) the increase in duodenal bicarbonate secretion in response to luminal acidification by approximately 80% (from 242 mol/cm per hour [CI, 41 to 443 mol/cm per hour] to 53 mol/cm per hour [CI, 107 to 197 mol/cm per hour]); a decrease was observed in each participant. In contrast, smoking had no significant effect on the response to luminal PGE2.

Conclusions: Cigarette smoking markedly inhibited acid-stimulated human duodenal mucosal bicarbonate secretion. This adverse effect of smoking may, at least in part, explain the role of cigarette smoking in the pathogenesis and natural history of duodenal ulcer disease.

Figures

Grahic Jump Location
Figure 1.
Effect of smoking on acid-stimulated duodenal mucosal bicarbonate secretion.bottomPP

The effect of sham smoking in seven smokers () and six nonsmokers () (top panel) and effect of smoking () or sham smoking () in 7 smokers ( ) on mean ( 95% CIs) net proximal duodenal mucosal bicarbonate secretion in response to acid (2 mmol HCl [100 mmol/L] infused intraduodenally during a period of 5 minutes). * < 0.05 compared with basal. < 0.05 compared with sham smoking.

Grahic Jump Location
Grahic Jump Location
Figure 2.
Effect of smoking on prostaglandin-E2-stimulated duodenal mucosal bicarbonate secretion.2P

Effect of sham smoking in seven smokers () and six nonsmokers () (top panel) and effect of smoking () or sham smoking () in seven smokers (bottom panel) on the mean ( 95% CIs) net proximal duodenal mucosal bicarbonate secretion in response to PGE (1.4 mol infused intraduodenally during a period of 30 minutes). No significant differences were found at any time between smoking and sham smoking. * < 0.05 compared with basal measurements.

Grahic Jump Location

Tables

References

Letters

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Comments

Submit a Comment
Submit a Comment

Summary for Patients

Clinical Slide Sets

Terms of Use

The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.

Toolkit

Buy Now

to gain full access to the content and tools.

Want to Subscribe?

Learn more about subscription options

Advertisement
Related Articles
Related Point of Care
Topic Collections
PubMed Articles

Buy Now

to gain full access to the content and tools.

Want to Subscribe?

Learn more about subscription options

Forgot your password?
Enter your username and email address. We'll send you a reminder to the email address on record.
(Required)
(Required)