Caecal pH is a biomarker of excessive colonic fermentation - PubMed (original) (raw)

Caecal pH is a biomarker of excessive colonic fermentation

Adam D Farmer et al. World J Gastroenterol. 2014.

Abstract

Aim: To ascertain whether caecal pH is different in patients with irritable bowel syndrome (IBS), whose primary symptoms are bloating and distension, to healthy controls.

Methods: Motility and pH data were reviewed from 16 patients with Rome III defined IBS and 16 healthy controls, who had undergone a wireless motility capsule (WMC) study using a standardized protocol. Motility measures were anchored around known anatomical landmarks as identified by compartmental pH changes. Sixty-minute epochs were used to quantify antral, duodenal, ileal, caecal and distal colonic contractility. The maximum and minimum pH was measured either side of the ileo-caecal junction.

Results: No differences were seen in motility parameters, compartmental transit times or maximal ileal pH between the two groups. Caecal pH was significantly lower in patients compared to controls (5.12 ± 0.05 vs 6.16 ± 0.15, P < 0.0001). The ileal:caecal Δchange was greater in patients than controls (-2.63 ± 0.08 vs -1.42 ± 0.11, P < 0.0001). There was a significant correlation between caecal pH and right colonic contractility (r = 0.54, P = 0.002).

Conclusion: Patients with bloating and distension have a lower caecal pH compared to controls. The measurement of caecal pH using the WMC provides a quantifiable biomarker of fermentation potentially identifying those patients that may preferentially benefit from antibiotic or dietary interventions.

Keywords: Bloating; Caecal pH; Caecoparesis; Colonic microbiota; Fermentation.

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Figures

Figure 1

Figure 1

A typical wireless motility capsule trace demonstrating temperature (blue line), pH (green line) and contractility (red line) across the ileo-caecal junction. The pH drop was defined as the difference between the stable ileal pH and the caecal pH nadir. ICJ: Ileo-caecal junction.

Figure 2

Figure 2

Differences (mean ± SD) in ileal, caecal and ileo-caecal junction pH drop between patients and controls. Caecal pH significantly lower in patients than in controls and pH drop across the ICJ was lower in patients than in controls. b_P_ < 0.01 vs patients group. ICJ: Ileo-caecal junction.

Figure 3

Figure 3

Caecal pH and caecal contractility was positively correlated (r = 0.54, P = 0.002). AUC: Area under the curve.

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