The stomach: a new and powerful oxalate absorption site in man

New information is provided regarding the site and nature of intestinal oxalate absorption in man. Intestinal absorption of oxalate was assessed indirectly from the increase in renal oxalate excretion following gastric administration of 5 mmol. oxalate loads. Four different types of loads have been used: sodium oxalate, sodium oxalate plus calcium gluconate, rhubarb and spinach. Studies were performed in 6 adult patients on permanent gastric tube feeding for various reasons. Gastric emptying was blocked by an intrapyloric balloon for the duration of the experiments and the gastric oxalate load was evacuated before the balloon was deflated. Under these conditions calcium oxalate was absorbed to the same extent as soluble oxalate. With increasing gastric loading time there is a linear increase in the urinary oxalate excretion: 15 to 21% of the gastric oxalate load appeared in the urine after 2 hours of loading, 24 to 45% after 4 hours and as much as 62% after 6 hours. These absorption kinetics and our experiment suggest that the stomach is not only just another oxalate absorption site but seems to be the critical site for intestinal oxalate absorption in an intact gastrointestinal tract. This finding opens a new field for the discussion of etiology and pathogenesis of calcium oxalate stone formation.