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ntent volume increased.¹⁶ A morę receiit study from the ne research group showed the fonnation of a "secretion ter" in the proximal stornach at the site of the meal-air

iURE 3. Axial magnetic resonance imaging (MRI) at 2 differ-t timepoints. In the first MRI image the stornach contour is tlined and the meal vdume is indicated by the hori/ontal lite arrow. Castric secretion can be identified as brighter MR nal compared with meal and intragastric air (black). In the :ond MRI image kidneys (K) and the liver (L) are marked for tter anatomie orientation. The secretion layer (bright signal) med and continuously increased at the meafair interface. produced with permission from John Wiley and Sons.

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stornach using scintigraphy (Fig. 4). They proved the scin-tigraphic activity was related to an actual volume of fluid by aspirating it 30 minutes after a meal of pancakes and orange juice. The average volume obtained was 70 mL. The scinti-graphic activity disappeared as the volume was aspirated and then recovered over a 10-minute period. Aspiration was performed again and this time 80 mL of fluid was aspirated. The pH of the initial aspirated fluid was 1.8.⁹

WHAT IS CAUSING THE ACID POCKET PHENOMENON?

Acid Pocket

The acid pocket forms due to the buflering elTect of food within the stornach. The acidity falls within the main stornach body where mixing of food and gastric juice is at its greatest. The pro.\imal stornach rela.\es after a meal and acts as a reservoir for food.¹⁶ Acid in this area will therefore escape the buflering eflect of the meal. The lack of mixing w ill also allow gastric juice to pool and form a layer of acid on top of the gastric contents.

In vitro experiments have been performed in an attempt to mimie the movement of food within these 2 areas of the stornach. When a blended meal and acid is allowed to settle. acid was shown to form a separate layer

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