Nocturnal antral pH rises are related to duodenal phase III retroperistalsis

The mechanisms behind nocturnal rises of gastric pH are unknown. We have analyzed the relation between interdigestive duodenal peristalsis and nocturnal pH in the gastric antrum. Simultaneous recording of antroduodenal pressures and intragastric pH was performed in 11 healthy subjects (six men, five women) overnight for 8 hr, using a catheter with seven pressure recording points and an antral glass pH electrode. Three pressure recording sites were closely spaced in the descending duodenum. Altogether 46 phase III activities were recorded. A retroperistaltic sequence in the last part of phase III was observed in 31 phase III activities (67.4%), while 15 phase III activities lacked retroperistalsis. All subjects had retroperistalsis in at least one phase III at night with a median of 60% (52-100%) (interquartile range). The duration of the whole phase III was 5.1 (3.1-7.0) min, whereas the duration of the retroperistaltic period was 2.0 (1.5-3.2) min, corresponding to 45% (23-64%) of the duration of phase III. The peak of antral pH occurred 7.4 (6.0-13.0) min from the start of the phase III in the duodenum and the rise in pH lasted for 8.0 (4.8-12.0) min. Measurement of pH for a period of 10 min before and after phase III, demonstrated an increase in median pH from 1.2 (1.1-1.9) to 3.2 (1.6-4.7), respectively (P < 0.001). Phase III activities without duodenal retroperistalsis were not followed by a significant antral pH change (median 1.7 vs 1.8 before and after phase III, respectively). Increases of pH unrelated to phase III were uncommon, only 1.0 (1.0-2.2) events per night were observed and lasted for a short period of time, 2.1 (0.5-3.2) min. The results indicate that the cyclic rise in antral pH at night is due to a physiological duodenogastric reflux, caused by duodenal retroperistalsis in phase III. This reflux may play a role in protection of the antral mucosa.