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Gastric acid pocket is a portion of unbuffered acid accumulations in the proximal stomach during postprandial period. It could be a reservoir of acid reflux in patients with gastroesophageal reflux disease (GERD). How proton pump inhibitors (PPIs) control the acid pocket is rarely known.Recently, Rohof et al1 reported PPIs might change the size, acidity, or position of the acid pocket, which contribute to the therapeutic effect in patients with GERD. Concurrent high resolution manometry and pH-impedance monitoring were performed in 36 patients with GERD (18 on PPIs and 18 off PPIs) after a standardized meal. The acid pocket was visualized using scintigraphy, and its size and position were measured using radionuclide markers. The pH of acid pocket was measured in its aspirates. In patients on PPIs, the number of acid reflux episodes was reduced, and the acid pocket was smaller and more frequently located below the diaphragm, and the mean pH of acid pocket was significantly higher. The number of reflux events was not altered by PPIs. It is interesting to show the acid pocket itself with and reflux episodes through a large hiatal hernia using scintigraphic images by the 99mTc-pertechnetate-labeling.

Proton Pump Inhibitors Reduce the Size and Acidity of the Gastric Acid Pocket (Clin Gastroenterol Hepatol 2014;12:1101-1107, e1)