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The Gastric Acid Pocket (or Coat) and Its Attenuation in Helicobacter pylori-infected Subjects

McColl, Kenneth, E.L., MD, FRCP, FMedSci, FRSE

Journal of Clinical Gastroenterology: January 2018 - Volume 52 - Issue 1 - p 1–5
doi: 10.1097/MCG.0000000000000939

In 2001, it was observed that the cardia region of the lumen of the stomach remained highly acidic after a meal and escaped the buffering effect of the food. This phenomenon was termed the acid pocket and is thought to explain why reflux symptoms occur after meals despite the buffering effect of food. This review describes the discovery of the acid pocket and our progress in understanding the intragastric physiology producing it, its exaggeration in hiatus hernia and role in reflux disease. The recent discovery that the acid pocket is attenuated in the Helicobacter pylori-infected population and the significance of this to the negative association between H. pylori and reflux disease and its complications is also addressed. Finally, the role of the acid pocket in providing protection from potentially pathogenic ingested microorganisms is discussed.

Institute of Cardiovascular & Medical Sciences, University of Glasgow, Gartnavel General Hospital, Glasgow, UK

The author declares that they have nothing to disclose.

Address correspondence to: Kenneth E.L. McColl, MD, FRCP, FMedSci, FRSE, Institute of Cardiovascular & Medical Sciences, University of Glasgow, Level 8, Gartnavel General Hospital, 1053 Great Western Road, Glasgow G12 0YN, UK (e-mail:

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