A report on associations among gastric pH, bleeding, duodenogastric reflux, and outcomes after trauma

Elizabeth Dial, Michelle Lopez-Storey, Sasha Adams, Lenard Lichtenberger, Ernest Gonzalez, Bruce McKinley, Frederick Moore, David Mercer

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

BACKGROUND: The pathogenesis of multiple organ failure (MOF) in trauma patients may involve the gastrointestinal tract, but its exact origins remain elusive. In a prospective study, the gastric fluid of major torso trauma patients was examined for evidence of duodenogastric reflux and potential gastric injury, and was compared with patient outcomes regarding MOF. METHODS: Patient samples were collected daily for 4 days by nasogastric tube and analyzed for pH, hemoglobin, and bile acid. Blood was collected for analysis of C-reactive protein (CRP). Outcomes were recorded for the presence or absence of MOF. RESULTS: The results showed that most patients exhibited alkaline gastric contents (pH ≥4.9) and elevated levels of hemoglobin immediately after the trauma. Although non-MOF patients demonstrated a decline of both mean gastric pH and bleeding by day 4, MOF patients maintained significant elevations in pH during this time period. Mean total bile acid levels were increased in all patients, signifying the presence of duodenogastric reflux. However, there were no clear differences in mean bile acid concentrations between MOF and non-MOF patients over time, although MOF patients tended to exhibit higher levels. All patients showed a progressive rise in serum CRP during the first 24 hours after trauma, which was maintained for 4 days. The initial rise in serum CRP in MOF patients was delayed compared with that in non-MOF patients. CONCLUSIONS: We conclude that duodenogastric reflux occurs in trauma patients in the first few days after trauma and may contribute to elevated gastric pH and bleeding. Further study is needed to verify whether monitoring the gastric juice of trauma patients during the first several days of hospitalization, for alkaline pH and excessive blood in the gastric lumen, could lead to better assessments of patient status.

Original languageEnglish (US)
Pages (from-to)105-110
Number of pages6
JournalJournal of Trauma - Injury, Infection and Critical Care
Volume64
Issue number1
DOIs
StatePublished - Jan 1 2008

Fingerprint

Duodenogastric Reflux
Stomach
Hemorrhage
Wounds and Injuries
Multiple Organ Failure
Bile Acids and Salts
C-Reactive Protein
Blood Proteins
Hemoglobins
Torso
Gastrointestinal Contents
Gastric Juice

Keywords

  • Duodenogastric reflux
  • Gastric pH
  • Trauma

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine

Cite this

A report on associations among gastric pH, bleeding, duodenogastric reflux, and outcomes after trauma. / Dial, Elizabeth; Lopez-Storey, Michelle; Adams, Sasha; Lichtenberger, Lenard; Gonzalez, Ernest; McKinley, Bruce; Moore, Frederick; Mercer, David.

In: Journal of Trauma - Injury, Infection and Critical Care, Vol. 64, No. 1, 01.01.2008, p. 105-110.

Research output: Contribution to journalArticle

Dial, Elizabeth ; Lopez-Storey, Michelle ; Adams, Sasha ; Lichtenberger, Lenard ; Gonzalez, Ernest ; McKinley, Bruce ; Moore, Frederick ; Mercer, David. / A report on associations among gastric pH, bleeding, duodenogastric reflux, and outcomes after trauma. In: Journal of Trauma - Injury, Infection and Critical Care. 2008 ; Vol. 64, No. 1. pp. 105-110.
@article{b2ca999d890f47c28556082c7a5c8c40,
title = "A report on associations among gastric pH, bleeding, duodenogastric reflux, and outcomes after trauma",
abstract = "BACKGROUND: The pathogenesis of multiple organ failure (MOF) in trauma patients may involve the gastrointestinal tract, but its exact origins remain elusive. In a prospective study, the gastric fluid of major torso trauma patients was examined for evidence of duodenogastric reflux and potential gastric injury, and was compared with patient outcomes regarding MOF. METHODS: Patient samples were collected daily for 4 days by nasogastric tube and analyzed for pH, hemoglobin, and bile acid. Blood was collected for analysis of C-reactive protein (CRP). Outcomes were recorded for the presence or absence of MOF. RESULTS: The results showed that most patients exhibited alkaline gastric contents (pH ≥4.9) and elevated levels of hemoglobin immediately after the trauma. Although non-MOF patients demonstrated a decline of both mean gastric pH and bleeding by day 4, MOF patients maintained significant elevations in pH during this time period. Mean total bile acid levels were increased in all patients, signifying the presence of duodenogastric reflux. However, there were no clear differences in mean bile acid concentrations between MOF and non-MOF patients over time, although MOF patients tended to exhibit higher levels. All patients showed a progressive rise in serum CRP during the first 24 hours after trauma, which was maintained for 4 days. The initial rise in serum CRP in MOF patients was delayed compared with that in non-MOF patients. CONCLUSIONS: We conclude that duodenogastric reflux occurs in trauma patients in the first few days after trauma and may contribute to elevated gastric pH and bleeding. Further study is needed to verify whether monitoring the gastric juice of trauma patients during the first several days of hospitalization, for alkaline pH and excessive blood in the gastric lumen, could lead to better assessments of patient status.",
keywords = "Duodenogastric reflux, Gastric pH, Trauma",
author = "Elizabeth Dial and Michelle Lopez-Storey and Sasha Adams and Lenard Lichtenberger and Ernest Gonzalez and Bruce McKinley and Frederick Moore and David Mercer",
year = "2008",
month = "1",
day = "1",
doi = "10.1097/TA.0b013e31815ebd99",
language = "English (US)",
volume = "64",
pages = "105--110",
journal = "Journal of Trauma and Acute Care Surgery",
issn = "2163-0755",
publisher = "Lippincott Williams and Wilkins",
number = "1",

}

TY - JOUR

T1 - A report on associations among gastric pH, bleeding, duodenogastric reflux, and outcomes after trauma

AU - Dial, Elizabeth

AU - Lopez-Storey, Michelle

AU - Adams, Sasha

AU - Lichtenberger, Lenard

AU - Gonzalez, Ernest

AU - McKinley, Bruce

AU - Moore, Frederick

AU - Mercer, David

PY - 2008/1/1

Y1 - 2008/1/1

N2 - BACKGROUND: The pathogenesis of multiple organ failure (MOF) in trauma patients may involve the gastrointestinal tract, but its exact origins remain elusive. In a prospective study, the gastric fluid of major torso trauma patients was examined for evidence of duodenogastric reflux and potential gastric injury, and was compared with patient outcomes regarding MOF. METHODS: Patient samples were collected daily for 4 days by nasogastric tube and analyzed for pH, hemoglobin, and bile acid. Blood was collected for analysis of C-reactive protein (CRP). Outcomes were recorded for the presence or absence of MOF. RESULTS: The results showed that most patients exhibited alkaline gastric contents (pH ≥4.9) and elevated levels of hemoglobin immediately after the trauma. Although non-MOF patients demonstrated a decline of both mean gastric pH and bleeding by day 4, MOF patients maintained significant elevations in pH during this time period. Mean total bile acid levels were increased in all patients, signifying the presence of duodenogastric reflux. However, there were no clear differences in mean bile acid concentrations between MOF and non-MOF patients over time, although MOF patients tended to exhibit higher levels. All patients showed a progressive rise in serum CRP during the first 24 hours after trauma, which was maintained for 4 days. The initial rise in serum CRP in MOF patients was delayed compared with that in non-MOF patients. CONCLUSIONS: We conclude that duodenogastric reflux occurs in trauma patients in the first few days after trauma and may contribute to elevated gastric pH and bleeding. Further study is needed to verify whether monitoring the gastric juice of trauma patients during the first several days of hospitalization, for alkaline pH and excessive blood in the gastric lumen, could lead to better assessments of patient status.

AB - BACKGROUND: The pathogenesis of multiple organ failure (MOF) in trauma patients may involve the gastrointestinal tract, but its exact origins remain elusive. In a prospective study, the gastric fluid of major torso trauma patients was examined for evidence of duodenogastric reflux and potential gastric injury, and was compared with patient outcomes regarding MOF. METHODS: Patient samples were collected daily for 4 days by nasogastric tube and analyzed for pH, hemoglobin, and bile acid. Blood was collected for analysis of C-reactive protein (CRP). Outcomes were recorded for the presence or absence of MOF. RESULTS: The results showed that most patients exhibited alkaline gastric contents (pH ≥4.9) and elevated levels of hemoglobin immediately after the trauma. Although non-MOF patients demonstrated a decline of both mean gastric pH and bleeding by day 4, MOF patients maintained significant elevations in pH during this time period. Mean total bile acid levels were increased in all patients, signifying the presence of duodenogastric reflux. However, there were no clear differences in mean bile acid concentrations between MOF and non-MOF patients over time, although MOF patients tended to exhibit higher levels. All patients showed a progressive rise in serum CRP during the first 24 hours after trauma, which was maintained for 4 days. The initial rise in serum CRP in MOF patients was delayed compared with that in non-MOF patients. CONCLUSIONS: We conclude that duodenogastric reflux occurs in trauma patients in the first few days after trauma and may contribute to elevated gastric pH and bleeding. Further study is needed to verify whether monitoring the gastric juice of trauma patients during the first several days of hospitalization, for alkaline pH and excessive blood in the gastric lumen, could lead to better assessments of patient status.

KW - Duodenogastric reflux

KW - Gastric pH

KW - Trauma

UR - http://www.scopus.com/inward/record.url?scp=38149115390&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=38149115390&partnerID=8YFLogxK

U2 - 10.1097/TA.0b013e31815ebd99

DO - 10.1097/TA.0b013e31815ebd99

M3 - Article

C2 - 18188106

AN - SCOPUS:38149115390

VL - 64

SP - 105

EP - 110

JO - Journal of Trauma and Acute Care Surgery

JF - Journal of Trauma and Acute Care Surgery

SN - 2163-0755

IS - 1

ER -