Assessment of vagotomy status with postprandial urinary alkaline tide.
OBJECTIVE
This study was carried out to assess whether the postprandial urinary alkaline tide, as a marker for the completeness of vagotomy, is dependent on the nature of the test meal, whether it is affected by proton pump inhibitor therapy, and whether it is reliable.


METHODS
The postprandial urinary alkaline tide (PUAT) pattern was prospectively assessed in three different study groups and one control group of healthy volunteers. The three study groups were as follows; A (n = 20) i.e. the Proton Pump Inhibitor (PPI) Group; B (n = 25) i.e. the Truncal Vagotomy (TV) Group; and C (n = 5) i.e. the Recurrent Ulcer (RU) Group. Urinary pH was measured by a pocket digital pH meter.


RESULTS
Postprandial urinary alkaline tide in the control group was significantly higher compared to the fasting levels. Liquid diet did not elicit a significant urinary alkaline tide response. There was a statistically significant fall in both fasting urinary pH (5.34 +/- 0.70 vs. 4.80 +/- 0.61, p = 0.031) and the postprandial alkaline tide (6.99 +/- 0.79 vs. 4.94 +/- 0.63, p = 0.0001) after taking proton pump inhibitors. In the truncal vagotomy and gastrojejunostomy group it was found that there was a significant fall in both the mean fasting (5.28 +/- 0.58, vs. 4.92 +/- 0.66, p = 0.032) and the postprandial urinary pH (6.29 +/- 0.92 vs. 5.09 +/- 0.73, p = 0.0001) following surgery.


CONCLUSIONS
This study establishes that simple measurement of the urinary pH before and after a standard test meal can be used as an accurate routine test for the completion of vagotomy. It also showed that proton pump inhibitors abolish the alkaline tide and therefore must be discontinued before measuring the alkaline tide. Liquid test meal was not effective in eliciting an alkaline tide as compared to a solid meal.
Longkumer
Tialiba
T
Department of Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry-605006, India.
Parthasarathy
G
G
Kate
Vikram
V
Ananthakrishnan
N
N
Koner
B C
BC
D004381:Duodenal Ulcer / Q000628:therapy* / Q000652:urine*; D005260:Female; D005745:Gastric Acidity Determination; D006801:Humans; D006863:Hydrogen-Ion Concentration; D008297:Male; D019095:Point-of-Care Systems; D019518:Postprandial Period / Q000502:physiology*; D054328:Proton Pump Inhibitors / Q000627:therapeutic use; D015203:Reproducibility of Results; D016896:Treatment Outcome; D015167:Vagotomy, Truncal
D054328:Proton Pump Inhibitors