The Results of Gastric pH-metry in Patients with Extensive Burns

Aim of study To study of the role of hydrochloric acid in the genesis of stress-induced gastric ulceration in patients with extensive burns.

Material and methods The results of gastroscopy and endoscopic pH-metry of 30 young patients with extensive burns (19 male patients and 11 female patients). The acidity of the gastric contents was measured on day 1,7 and 14 after the trauma.

Results It was found that the early period of burn disease was followed by the pH growth in the acid-producing area of the stomach to 3.8–4.2 (p=0.002–0.020). This indicated that extensive burns provoked a significant decrease of  hydrochloric acid production by parietal cells of the stomach. The restoration of the acid production occurred only 14 days after thermal injury and was not followed by the development of a hyperacid state. The frequency of erosive-ulcerative lesions detection in the gastric mucosa by the end of the first day after receiving burns was 83%, 87% on day 7, and 96% on day 14. In total, stress-induced lesions of the gastrointestinal mucosa were diagnosed in 26 of 30 patients with a shock-induced thermal injury. Consequently, in patients with burn shock the protective factors of the gastric mucosa were depressed so that a minimum amount of hydrochloric acid was sufficient to damage it.

Conclusion Inhibition of acidogenic function is typical for patients with burn disease. Hydrochloric acid does not play a leading role in the genesis of stressinduced ulceration in patients with severe thermal trauma.

1. Evseyev M.A. Prevention of stress erosive and ulcerative lesions of the gastroduodenal zone in patients in critical conditions. Russkiy meditsinskiy zhurnal. 2008; (29): 2012–2018. (In Russian).

2. Orobey YU.A., Lazebnik L.B., Nikolayev E.I., et al. Risk factors affecting the development of gastroduodenal bleeding. Eksperimental’naya i klinicheskaya gastroenterologiya. 2010; (12): 31–36. (In Russian).

3. Barletta J.F., Erstad B.L., Fortune J.B. Stress ulcer prophylaxis in trauma patients. Crit Care. 2002; 6(6): 526–530. PMID: 12493075.

4. Cook D.J., Fuller H.D., Guyatt G.H., et al. Risk factors for gastrointestinal bleeding in critically ill patients. N Engl J Med. 1994; 330(6): 377–381. PMID: 8284001. DOI: 10.1056/NEJM199402103300601.

5. Pimentel M., Roberts D.E., Bernstein C.N., et al. Clinically significant gastrointestinal bleeding in critically ill patients in an era of prophylaxis. Am J Gastroenterol. 2000; 95(10): 2801–2807. PMID: 11051351. DOI: 10.1111/j.1572-0241.2000.03189.x.

6. Sijacki A.D., Popovic N., Karamorkovic A., et al. Risk factors for bleeding from stress ulcer in severely injured and critically ill persons. Acta Chir Iugosl. 2007; 54(1): 77–81. PMID: 17633866.

7. Pugachev M.I., Dobrovol’skaya L.M., Ivanov V.V., et al. Insulin and certain steroids secretion in patients with varying severity of burn disease. Vestnik Severo-Zapadnogo gosudarstvennogo meditsinskogo universiteta im II Mechnikova. 2014; (4): 26–32.

8. Yurova Yu.V. Diagnostics of readiness of granulating burn wounds for free autodermoplasty: Cand. med. sci. diss. synopsis. Saint Petersburg, 2014. 20 p. (In Russian).

9. Kalashnikov A.Yu. Endoscopic diagnosis of mucosal lesions of the upper gastrointestinal tract in patients with thermal burns of the body: Cand. med. sci. diss. synopsis. Moscow, 2005. 23 p. (In Russian).

10. Siah S., Fouadi F.E., Ababou K., et al. Les hemorragies gastroduodenales de stress chez le brule grave. Ann Burns Fire Disasters. 2008; 21(4): 199–202. PMID: 21991137.

11. Garcia L. Stress ulcer prophylaxis: When, What drug and How long? Drug Therapy Topics. 2002; 31(7): 35–38.

12. Spiridonova T.G. Multiple organ dysfunction and insufficiency in burned: Dr. med. sci. diss. synopsis. Moscow, 2007. 51 p. (In Russian).

13. Daley R.J., Rebuck J.A., Welage L.S., et al. Prevention of stress ulceration: current trends in critical care. Crit Care Med. 2004; 32(10): 2008–2013. PMID: 15483408. DOI: 10.1097/01.CCM.0000142398.73762.20.

14. Spirt M.J. Stress-related mucosal disease: risk factors and prophylactic therapy. Clin Ther. 2004; 26(2): 197–213. PMID: 15038943.

15. Mikheyev A.G., Yakovlev G.A. Recommendations for use of pH-probes and ZpH-probes. Moscow: NPP Istok-sistema Publ., 2013. 27p. (In Russian).

16. Sotnikov V.N., Dubinskaya T.K., Volova A.V, et al. The value of endoscopic pH-metry in the definition of acid-producing function of the stomach. Moscow: NPP Istok-sistema Publ., 2005. 27 p. (In Russian).

17. Vagner D.O. Prevention of gastroduodenal bleeding in patients with shockogenic thermal trauma: Cand. med. sci. diss. synopsis. Saint Petersburg, 2016. 24 p. (In Russian).

18. Kolesnikova I.Yu., Volkov V.S. Diagnosis and treatment of acid-dependent diseases of the digestive tract. Moscow: Meditsinskoye informatsionnoye agentstvo Publ., 2014. 429 p. (In Russian).

19. Il’chenko A.A., Selezneva E.Ya. Computer pH-metry of the stomach and esophagus. Clinical significance of the method. Moscow: Departament zdravookhran