Bile salt induced back diffusion of hydrogen ions across gastric mucosa in man. Fact or fiction?

We studied the effect of 5.5 mM bile salts, consisting of taurine conjugates in 5 normal subjects. Bile salts caused a significant increase in H+ loss from and Na+ movement into the gastric lumen (controls 1.5 mEq H+, 1.5 mEq Na+; bile salts -3.1 mEq H+ (p less than 0.001), Na+ 2.5 mEq (p less than 0.01) per 15 min.) To determine the effect of acid secretion, studies were repeated after i.v. atropine 2 mg/70 kg b.w. Atropine reduced net H+ flux to -0.2 mEq and Na+ gain to 0.9 mEq. When the bile salt studies were repeated after i.v. atropine, net H+ loss was increased to -5.4 mEq H+, significantly greater than with bile salts alone; corresponding Na+ gain was 3.2 mEq/15 min. The volume of fluid secreted was 25.0 ml in the bile salt study compared with 14.0 ml in the atropine and bile salt study. Even if all the additional volume 'secreted' (14 ml) were bicarbonate from the stomach or pancreatic juice with a concentration of 145 mEq/liter, it could account for a loss of only 2.0 mEq H+. In conclusion, atropine with bile salts is associated with a loss of H+ ions too great to be accounted for by bicarbonate neutralization. We conclude that back diffusion of H+ ions is the most likely explanation of H+ loss after bile salts in man.