CHANGES IN THE COMPOSITION OF GASTRIC JUICE IN ACHALASIA CARDIAE AND HIATAL HERNIA
DOI:
https://doi.org/10.11603/mcch.2410-681X.2026.i1.15932Keywords:
gastric juice; achalasia cardiae; hiatal hernia; pepsin; glycoproteins; bile acids; nitric oxide; calcium.Abstract
Introduction. Gastric juice is a key component of the digestive system, ensuring the digestion of food, protecting the gastric mucosa, and regulating the motor and secretory functions of the upper gastrointestinal tract. Impaired relaxation of the gastric sphincter apparatus, particularly in achalasia of the cardia and hiatal hernia, is accompanied by altered esophageal and gastric motility and the development of reflux phenomena, which may lead to changes in the physicochemical and biochemical characteristics of gastric juice and the mucosa of the upper digestive tract. The aim of the study was to assess changes in gastric juice volume and physicochemical and biochemical parameters in patients with achalasia cardiae and hiatal hernia compared with a control group. Research methods. The study included 150 patients with impaired relaxation of the gastric sphincter apparatus, including 50 patients with achalasia of the cardia and 100 patients with hiatal hernia. The control group consisted of 20 apparently healthy individuals. Gastric juice volume, pH level, concentrations of pepsin, glycoproteins, bile acids, calcium ions (Ca2+), and total nitric oxide metabolites (NOx ) were determined. Data were presented as median and interquartile range – Me (Q25; Q75). Nonparametric statistical methods were applied. Results and Discussion. Gastric juice volume was significantly increased compared with the control group: by 2.9-fold in achalasia of the cardia and by 2.2-fold in hiatal hernia (p < 0.001). Pepsin concentration decreased by 1.9-fold and 1.6-fold, respectively, while glycoprotein levels decreased by 7.0-fold and 7.8-fold (p < 0.001). Concentrations of bile acids and NOx were increased by 1.8-fold and 1.7-fold in achalasia, and by 1.4-fold and 3.5-fold in hiatal hernia, respectively. Gastric pH did not differ significantly between groups, whereas changes in Ca2+ concentration showed borderline statistical significance. The most pronounced differences were observed for glycoproteins and NOx, indicating impairment of mucosal protective mechanisms and activation of nitroxidergic regulatory pathways. Conclusions. Achalasia cardiae and hiatal hernia are associated with complex alterations in the volume and composition of gastric juice, reflecting combined disturbances of motor-evacuatory, protective, and regulatory gastric functions.
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Accepted 2026-03-01
Published 2026-04-28
