Abstracts
2002 Digestive Disease Week

# 106862 Abstract ID: 106862 Intragastric and Intestinal PH Profiles after Surgical Treatment for Chronic Pancreatitis
R c i van Geenen, W P Geus, C Penning, D J Gouma, A A M Masclee, Amsterdam, Netherlands; Den Haag, Netherlands; Leiden, Netherlands

Background: Chronic pancreatitis can be treated by resection procedures such as duodenum preserving resection of the pancreatic head (DPRHP) or a pylorus preserving pancreaticoduodenectomy (PPPD). Resection may interfere with the complex mechanisms that regulate nutrient digestion. Gastrointestinal pH has a major influence on digestion especially on lipase activity. Previously we found that in patients with chronic pancreatitis postprandial intestinal and intragastric pH are significantly reduced. The effect of resection on gastrointestinal pH profiles in these patients is unknown. Therefore we analysed gastrointestinal pH in patients after PPPD in comparison to non-operated chronic pancreatitis patients (CP). Methods: Six patients after PPPD (33-69 yr), 6 after DPRHP (30-57 yr) and 9 CP patients (28-66 yr) were studied. Patients underwent 24 hour ambulatory continuous intragastric and intestinal pH measurements under standardised conditions (meal intake, supine period) with the intestinal pH probe positioned 10-15 cm distal from the pylorus. Results: All patients had impaired exocrine function of comparable degree measured by urinary PABA recovery and fecal fat excretion (fat: 31 ± 12, 25 ± 9 and 24 ± 6 g/24h in PPPD, DPRHP and CP resp.). Median 24h intragastric pH of PPPD, DPRHP, and CP patients were 1.7 (IQR 1.6-2.9), 1.7 (IQR 1.4-2.2), and 1.6 (IQR 1.3-2.1) respectively (NS). Median 24h intestinal pH was 6.2 (IQR 6.0-6.5), 5.9 (IQR 4.3-6.6), and 5.9 (IQR 5.0-6.6), respectively (NS). When divided into 4 circadian periods, in the nocturnal period from 22-06 hours intestinal pH in the PPPD group was significantly higher than in DPRHP group, 6.2 vs. 5.8 (p=0.05). Conclusion: Median 24h intragastric and intestinal pH profiles in patients after PPPD and DPRHP are not significantly different from non-operated chronic pancreatitis patients. Surgery does not negatively interfere with intraluminal pH and subsequent nutrient digestion.