title: An assessment of human gastric fluid composition as a function of PPI usage.
abstract: The standard of care for chronic gastro-esophageal reflux disease (GERD), which affects up to 40% of the population, is the use of drugs such as proton pump inhibitors (PPIs) that block the production of stomach acid. Despite widespread use, the effects of PPIs on gastric fluid remain poorly characterized. In this study, gastric fluid was collected from patients undergoing cardiac surgery who were not (n = 40) or were (n = 25) actively taking PPIs. Various enzymatic and immunoassays as well as mass spectrometry were utilized to analyze the concentrations of bile, gastricsin, trypsin, and pepsin in the gastric fluid. Proteomic analyses by mass spectrometry suggested that degradation of trypsin at low pH might account, at least in part, for the observation that patients taking PPIs have a greater likelihood of having high concentrations of trypsin in their gastric fluid. In general, the concentrations of all analytes evaluated varied over several orders of magnitude, covering a minimum of a 2000-fold range (gastricsin) and a maximum of a 1 × 10(6) -fold range (trypsin). Furthermore, the concentrations of various analytes were poorly correlated with one another in the samples. For example, trypsin and bile concentrations showed a significant (P < 0.0001) but not strong correlation (r = 0.54). Finally, direct assessment of bacterial concentrations by flow cytometry revealed that PPIs did not cause a profound increase in microbial load in the gastric fluid. These results further delineate the profound effects that PPI usage has on the physiology of the stomach.
authors: Department of Surgery, Duke University Medical Center, Durham, North Carolina.
authors: Emily
authors: E
authors: Foltz
authors: Toronto General Research Institute, Toronto General Hospital, Toronto, Ontario, Canada.
authors: Sassan
authors: S
authors: Azad
authors: Department of Surgery, Duke University Medical Center, Durham, North Carolina.
authors: Mary Lou
authors: ML
authors: Everett
authors: Department of Surgery, Duke University Medical Center, Durham, North Carolina.
authors: Zoie E
authors: ZE
authors: Holzknecht
authors: Department of Surgery, Duke University Medical Center, Durham, North Carolina.
authors: Nathan L
authors: NL
authors: Sanders
authors: Department of Pharmacology and Cancer Biology, Duke University Medical Center, Durham, North Carolina Duke Proteomics and Metabolomics Core Facility, Duke University Medical Center, Durham, North Carolina.
authors: J Will
authors: JW
authors: Thompson
authors: Duke Proteomics and Metabolomics Core Facility, Duke University Medical Center, Durham, North Carolina.
authors: Laura G
authors: LG
authors: Dubois
authors: Department of Surgery, Duke University Medical Center, Durham, North Carolina.
authors: William
authors: W
authors: Parker
authors: Toronto General Research Institute, Toronto General Hospital, Toronto, Ontario, Canada.
authors: Shaf
authors: S
authors: Keshavjee
authors: Department of Medicine, Duke University Medical Center, Durham, North Carolina.
authors: Scott M
authors: SM
authors: Palmer
authors: Department of Surgery, Duke University Medical Center, Durham, North Carolina.
authors: R Duane
authors: RD
authors: Davis
authors: Department of Surgery, Duke University Medical Center, Durham, North Carolina Department of Immunology, Duke University Medical Center, Durham, North Carolina.
authors: Shu S
authors: SS
authors: Lin
keywords: Bile; gastric fluid; gastricsin; proton pump inhibitors; trypsin
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