Gastric Alkalinization

Abstract

The increase in lower-esophageal-sphincter pressure after gastric alkalinization has been attributed to endogenous gastrin release. The sphincter response to four different alkalinizing agents and serum gastrin levels were compared in 10 normal subjects. Despite increases in sphincter pressure after gastric alkalinization, serum gastrin levels did not change significantly. Serum gastrin levels and lower-esophageal-sphincter pressure did decrease after 30 minutes of gastric acidification. Although the pressure increased with subsequent gastric alkalinization, serum gastrin levels did not change from the depressed post-acidification level. Finally, in five patients with peptic-ulcer disease, calcium carbonate increased sphincter pressure at a time when serum gastrin levels were unchanged. When serum gastrin levels did increase, sphincter pressure had returned toward basal levels. These observations confirm the effect of gastric alkalinization in increasing the pressure, but suggest that endogenous gastrin release has little, if any, role in this response. (N Engl J Med 291:486–490, 1974)