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Gastric tonometry in assessing splanchnic tissue perfusion in acute pancreatitis
P O Juvonen1, E M Alhava, J A Takala
1Dept. of Surgery, Critical Care Research Programme, Kuopio University Hospital, Finland.
Background:
Hypovolemia is typical early in acute pancreatitis. Despite fluid resuscitation splanchnic hypoperfusion may be present and may have a role in the course of pancreatitis. To test this hypothesis, we assessed gastric mucosal pH (pHi) and P(CO)2 during the first 48 h of hospitalization for acute pancreatitis.
Methods:
Thirty-three patients were studied. A gastric tonometer was inserted on admission, and gastric mucosal pH and P(CO)2 were measured on admission and then every 12 h during next 48 h.
Results:
On the basis of the Atlanta classification there were 22 cases of mild and 8 of severe pancreatitis. Three patients were excluded because of consent withdrawal. The groups were similar with regard to age, sex ratio, and etiology of pancreatitis. Independently of disease severity the gastric pHi decreased, and the gastric mucosal-arterial P(CO)2 difference and pH difference both increased over time as compared with base line. No difference was seen in these values between mild and severe pancreatitis.
Conclusions:
Moderate gastric mucosal hypoperfusion was found early in acute pancreatitis. However, gastric pHi measurement with tonometry has no obvious value as a screening tool to assess the severity of pancreatitis.