Gastric acid
The main constituent of gastric acid is hydrochloric acid which is produced by parietal cells (also called oxyntic cells) in the gastric glands in the stomach. Its secretion is a complex and relatively energetically expensive process. Parietal cells contain an extensive secretory network (called canaliculi) from which the hydrochloric acid is secreted into the lumen of the stomach. The pH of gastric acid is 1.5 to 3.5 in the human stomach lumen, the acidity being maintained by the proton pump H/K ATPase. The parietal cell releases bicarbonate into the bloodstream in the process, which causes a temporary rise of pH in the blood, known as an alkaline tide.
Esophageal pH monitoring
In assessment of distal esophageal pH, the sensor is placed 5 cm above upper border of the lower esophageal sphincter (LES) determined by esophageal manometry. To measure proximal esophageal acid exposure the second sensor is placed 1-5 below the lower border of the upper esophageal sphincter (UES). The Bravo pH capsule is placed either transnasally based on manometric measurements, or following endoscopy. In transnasal placement the capsule is placed 5 cm above upper border of the LES, and in endoscopic placement 6 cm above gastroesophageal junction. The same applies to OMOM pH monitoring capsule.