Buffering effect is quantified as the slope of the relationship between internal forest temperature and external temperature, with low values representing strong buffering effects. All rights reserved. Arch Pathol Lab Med. These include: The duodenum is a key organ in digestion, and symptoms may suggest a health condition that requires treatment. This physiologic effect could explain the low incidence of stomal ulcers. buffering effect in duodenumvolkswagen do brasil balanced scorecard weaknessesvolkswagen do brasil balanced scorecard weaknesses A buffering effect is a process in which a psychosocial resource reduces the impact of life stress on psychological well-being. Explain why cells in the intestinal lumen have microvilli. Secretion of bicarbonate into the adherent layer of mucus gel creates a pH gradient with a near-neutral pH at the epithelial surfaces in stomach and duodenum, providing the first line of mucosal protection against luminal acid. Celiac disease and other causes of duodenitis. The duodenum acts as a barrier to prevent harmful microbes from entering the body. Which of the following do you think would have the worst effect on digestion: surgical removal of the pancreas, gallbladder, or stomach? Definition. The capacity of the duodenum to neutralize, buffer and to dilute acid. The duodenum is considered the mixing pot of the small intestine because of the churning process that takes place there. The duodenum can be affected by a number of health conditions common to people of any age. Describe how lipids are digested and absorbed. We have previous experience in measuring pH in the jejunum, just below the level of gastrojejunal anastomosis in RYGBP, where pH was below four in 10.5 (0.337.7) percent of the time during more than 24h of continuous registration [18]. 2023 Dotdash Media, Inc. All rights reserved. He describes his pain as gnawing, burning (maybe a 4 out of 10 on a pain scale) and points to the epigastric region of his abdomen. 2. The duodenum usually buffers the caustic effects of gastric acid . The duodenum is affected by disorders or disease that may be acute (short-term and severe) or chronic (long-term). (b) Why is this necessary? Chugging low-fi computers, high-tech data exchanges, harsh glitches and noise, UI sounds, power ups and power downs, intricate mechanisms, robotic and mechanical buzzes, record scratch-like effects, buffer effects can create them all. How does this modification relate to the function of the stomach? We'll also test the biopsy for cancer because of your family history. It then enters the duodenum, to begin the body's process of absorbing vitamins, minerals, and other nutrients. What releases bicarbonate into the duodenum? The duodenum buffers the acidic gastric chyme by releasing mucus secretions that contain high levels of alkalinity. A condition affecting the duodenum may not result in any symptoms at all. She has worked in the hospital setting and collaborated on Alzheimer's research. Sherry Christiansen is a medical writer with a healthcare background. Gastric ulcers on the other hand are usually caused by hypersecretion . Buffering refers to the neutralization of gastric acidity by the bicarbonate present in the pancreatic juice. Explain how contraction of the gastrointestinal smooth muscle is intrinsically controlled. In whag ways does this protect the duodenum? Explain why acid reflux into the esophagus damages the esophageal wall and causes pain, whereas gastric juice does not typically irritate the stomach lining. PDF | IntroductionBariatric procedures result in massive weight loss, however, not without side effects. What is the function of bicarbonate in the duodenum? As expected, the difference between pre- and postpyloric pH was reduced during meals, when ingested food increased the gastric pH. in what way does this protect the duodenum? Explain the pathway of bile to the duodenum. malaysian embassy in london job vacancy; baku swimwear castle hill; milele fm presenters. We did not achieve full 24-h registrations in all patients, which could be regarded as a weakness, especially since four patients had to be excluded from the analysis regarding pH difference before and during meals. a. hydrochloric acid b. pepsinogen c. pepsin. ROOPAM S answered on December 06, 2021. You'll get a detailed solution from a subject matter expert that helps you learn core concepts. The buffering effect means the neutralization of pH or the maintenance of acid base balance in an area. Mongolian gerbils develop duodenal ulcer after H pylori infection5. Our website is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Cryoprotective agents, including nitrogen sources such as amino acids, saccharides, sugars such as trehalose, sucrose, and lactose, and alcohols, such as sorbitol and mannitol, are frequently added to reduce cell damage during freeze-drying. The buffering effect is the neutralization of the acidic chyme that arrives in the duodenum of the small intestine. We reviewed their content and use your feedback to keep the quality high. a. hydrochloric acid b. pepsinogen c. pepsin. | Find, read and cite all the research . A written consent was obtained from all participants. Describe the transport of pancreatic juice from the pancreas to the duodenum. Log in with Facebook Log in with Google. What are the causes of peptic ulcer disease and how does it present? In our previous measurements, just below the gastrojejunal anastomosis, in 21 RYGBP-patients, median percentage of time with pH<4 was 10.5% [18], compared to 13.0% in the present study. ", Later that month, the endoscopy is performed and it confirms Dr. Lorraine's suspicions. Buffers do so by being composed of certain pairs of solutes: either a weak acid plus a salt derived from that weak acid or a weak base plus a salt of that weak base. Explain the pathway of bile to the duodenum. The acidity of the gastric contents is therefore less than that of the pure gastric juice secreted bya pouch (KahnandYaure, 1924). Bicarbonate acts to regulate pH in the small intestine. The difference in mean pH before and during meals was then calculated. Kendrick ML, Dakin GF. The production of large amounts of ketone bodies is often seen when glucose is not readily available as an energy source (e.g. Digestion. Explain in terms of the anatomy of the digestive system. This physiologic effect could contribute to the low incidence of marginal ulcers. Several tests are commonly used to diagnose conditions of the duodenum, including duodenitis. In what ways does this protect the duodenum? Dr. Lorraine explains to Sal, "Mr. Volpe, you do not have stomach cancer, but you do have a duodenal ulcer caused by the H. pylori bacteria I was telling you about. What does the "buffering effect" mean? Although conventional placement of the BRAVO-capsule is done after removal of the endoscope, we used direct endoscopic guidance to place the two capsules. As a result, pathogens (disease-causing germs) have a difficult time multiplying there. The possibility for patients to continue with their ordinary life, without having nasogastric catheters, and the possibility to perform detailed measurements, for example before and after meals have been favorable with the present technique. Accessibility Nausea and vomiting: This is due to the irritation of the duodenum and often occurs along with the pain. How does the duodenum accomplish this? Postgrad Med J 1974; 50: 683-8. The medication Pepcid that Mr. Volpe took for partial relief of his dyspepsia is called an H2 (histamine) receptor antagonist, or H2 blocker. What does she mean by the "buffering effect?" In the discussion, include all organs and intermediates involved in the process. (b) What is its function? The https:// ensures that you are connecting to the buffering effect in duodenum. Explain the functions associated with the low pH environment of the stomach. The duodenum submucosal glands secret large amount of mucus and urogastrone. What is the influence of histamine in the gastrointestinal system? (b) Describe two of its secretions. For example, the duodenum is a common source of abdominal discomfort, with symptoms of indigestion, heartburn, and upper abdominal pain affecting approximately 25% of the population. Another example of a buffer is a solution . All other trademarks and copyrights are the property of their respective owners. What effect would cutting the vagus nerve branch that innervates the stomach have on gastric function? DS consists of two different parts. What does she mean by Salivation is controlled almost entirely by the nervous system. Guyton and Hall textbook of medical physiology. The duodenal bulb is divided two to 4cm distal to the pylorus and anastomosed to the last 2.5-m of distal ileum (alimentary limb). Moreover, intragastric and duodenal pH monitoring has been implemented with BRAVO system with good reliability and promising results [1117]. What is the function of the enzyme pepsin? What are the buffers that can counteract alkalosis? What are the effects of the sympathetic nervous system on digestive functions? That means it prevents histamine release. Would pepsin work on amylase? High protein meals thus stimulate much acid secretion by the gastric mucosa and also buffer the acid secreted. In order to understand the disease in Mr. Volpe's alimentary canal, one must know the layers that make up its walls. Gastric acid is known to cause marginal ulcers, situated in the small bowel just distal to the upper anastomosis. The study was approved by the Regional ethical review board of Uppsala University (Dnr. Discuss how the stomach protects itself from this acidic environment. What is the buffering effect; how does the duodenum accomplish this? BRAVO catheter-free pH monitoring: normal values, concordance, optimal diagnostic thresholds, and accuracy. The American Journal of Digestive Diseases 2 , 288-293 ( 1935) Cite this article. Sometimes the stomach stops producing HCl. Strignano P, Collard JM, Michel JM, Romagnoli R, Buts JP, De Gheldere C, et al. DOI: 10.1007/s11695-017-2574-0 Corpus ID: 19072062; Large Buffering Effect of the Duodenal Bulb in Duodenal Switch: a Wireless pH-Metric Study @article{Bekhali2017LargeBE, title={Large Buffering Effect of the Duodenal Bulb in Duodenal Switch: a Wireless pH-Metric Study}, author={Zakaria Bekhali and Jakob Hedberg and Hans Hedenstr{\"o}m and Magnus Sundbom}, PDF | IntroductionBariatric procedures result in massive weight loss, however, not without side effects. Suzuki T, Yamaguchi T, Odaka T, Kobayashi M, Seza A, Kouzu T, et al. This large secretion in the empty stomach without the buffering effect of food makes the gastric content very corrosive and, when it is hurried onward into the duodenum by the gastric hypermotility, produces the chronic progressive ulcer in the less resistant duodenal mucosa. What does she mean by the "buffering effect?" How does the duodenum accomplish this, and in what way does this protect the duodenum? (a) What are the major functions of the stomach? It was clear that ocean water displayed a strong buffer system to counteract the effects of hydrogen ions dissociating in the solution. What is the function of this adaptation? Explain the regulation of pancreatic juice and bile secretion. The site is secure. The role of included duodenal bulb in this has not been investigated. Where does bicarbonate come from in the duodenum? (b) What is its function? Dr. Lorraine tells him that the, Dr. Lorraine also explains to Mr. Volpe that. In our case, registration time was anyhow limited to 24h, by allowing all data from the two parallel BRAVO-capsules to be recorded on one receiver. Hess DS, Hess DW, Oakley RS. The small intestine is a long convoluted organ of the digestive tract which is divided into three distinct regions called the duodenum, jejunum, and ileum. Brunner's glands: a structural, histochemical and pathological profile. Registration time and pH data, presented in median (range) and SD, in the 15 studied DS patients, Wilcoxon matched-pair signed rank test was used for all comparisons, Difference in pre- and postpyloric pH before and during six meals. What does the "buffering effect" mean? What cells are involved and what do they secrete? What does she mean by the "buffering effect?". Ono S, Kato M, Ono Y, Asaka M. New method for long-term monitoring of intragastric pH. Where is the epigastric region and what organs associated with digestion are located in that area? Duodenal mucosal mechanisms of protection The duodenum is the most proximal part of the small intestine, into which the stom-ach intermittently expels chyme with a high concentration of HCl. The following example shows the effects of buffering. She discovers that Sal has a family history for gastrointestinal cancer and has unintentionally lost 10 pounds since his checkup a year ago. Buffer Effects. Bariatric procedures result in massive weight loss, however, not without side effects. What effect would cutting the vagus nerve branch that innervates the stomach have on gastric function? The structures in the epigastric region share a common nerve supply. FOIA How does the "peri" prefix apply to the mechanism of peristalsis? Chang JH, Choi MG, Yim DS, Cho YK, Park JM, Lee IS, et al. Duodenum is the first part of the small intestine which takes View the full answer Previous question Next question Digestion* Peptic Ulcer* or. 8600 Rockville Pike Why do most other types of bacteria not produce ulcers? It may be diagnosed when a person is being examined for another type of digestive disorder. Why doesn't the stomach normally digest itself? Protein digestion is partially accomplished by pepsin, an enzyme that works best in a pH range of 1.5 to 2.5. The lumen of the duodenum secretes bicarbonate to protect against the HCl in the chyme going through the duodenum. Collectivelyin addition to the esophagusthe stomach, large intestine, and accessory organs (such as the liver and pancreas), along with the duodenum and the other two sections of the small intestine, form what is commonly referred to as the GI tract. Helicobacter pylori produces virulence factors that induce an inflammatory response. Also, explain what enzymes interact with the different foodstuffs. How does the stomach protect itself from digestion? (a) Explain how the stomach is protected from self-digestion. In Gcg iCre Ai32 mice, a blue laser beam was directed to the terminal Postgrad Med J 1974; 50: 683-8. How does the duodenum accomplish this,and in what way does this protect the duodenum? Pathway of Chyme in Small Intestine: The duodenum receives. How would damage to the vagus nerve impact the digestive process? Discuss how the stomach protects itself from this acidic environment. Search life-sciences literature (41,842,822 articles, preprints and more) Search. Experts are tested by Chegg as specialists in their subject area. In whag ways does this protect the duodenum? No correlation was seen to the measured pH levels. The bicarbonate buffer system is an acid-base homeostatic mechanism involving the balance of carbonic acid (H 2 CO 3), bicarbonate ion (HCO 3), and carbon dioxide (CO 2) in order to maintain pH in the blood and duodenum, among other tissues, to support proper metabolic function. (a) Define lower esophageal sphincter. By this wireless pH-metric technique, we could demonstrate that the duodenal bulb had a large buffering effect, thus counteracting the large amount of gastric acid passing into the small bowel after duodenal switch. The location of the capsules was verified by repeated fluoroscopy when the patient returned the recording device on the following day. During the 24-h registration, patients were encouraged to eat at their leisure. The friendly bacteria in the duodenum and other parts of the small intestine take up space and compete for food inside the duodenum. 1. 7. What does she mean by the "buffering effect?" How does the duodenum accomplish this, and in what way does this protect the duodenum? The reduction of acidity of chyme is accomplished by the duodenum through the presence of the alkaline substance called bicarbonate ions. Theoretically, bile reflux could also contribute to a reduced ulcer incidence, but in DS this requires a retrograde flow through 150cm of the alimentary limb, which seems unlikely. How do secretin and cholecystokinin inhibit the stomach? When the doctor knocks and walks in, she finds the 66-year-old man looking exhausted and uncomfortable. The mucus helps protect the duodenum because it contains bicarbonate ions that help raise the pH of chime. To enhance passage through the pylorus, the soft tip of delivery system was grasped by an endoscopic snare. a. Coblijn UK, Lagarde SM, de Castro SM, Kuiken SD, van Wagensveld BA. The duodenal lumen is exposed to aggressive factors with a high potential to cause damage to the mucosa. Luminal lavage of the donor intestine was attempted in the 1990 s but later abandoned due to . Explain how peristalsis aids with physical movement of food through the alimentary canal? We have used the wireless BRAVO system to study the buffering effect of the duodenal bulb in duodenal switch (DS), a procedure in which the gastric sleeve produces a substantial amount of acid. Comparison of gastric body and antral pH: a 24hour ambulatory study in healthy volunteers. The significance of the neutralizing and buffering effect of the duodenal secretions. Some of those mechanisms are large amounts of mucus and alkaline secretions, as well as water from the pancreas and gallbladder. b. Explain the contributions that the liver and pancreas make to the digestive process. Results Perceived organizational support was found to influence the mediating effect of work and sparingly soluble in ethanol. Over a length of only 25 cm, large volumes of strong acid secreted by the stomach must be converted to the neutral-alkaline chyme of the hindgut lumen, generating large volumes of CO (2). (a) Explain why this surgery would h. How does the parasympathetic system influence the intestinal system? In conclusion, we could demonstrate that the duodenal bulb has a large buffering effect, thus counteracting the large amount of gastric acid passing into the small bowel after duodenal switch. The .gov means its official. Describe how blocked bile ducts would adversely affect digestion. (b) What is its function? Why is bicarbonate in the duodenum necessary? What roles does the pancreas play in digestion? Describe the functions of the following components of gastric juice. For example, a pancreaticoduodenectomy (Whipple procedure) can be done to treat duodenal and pancreatic cancer. Experts are tested by Chegg as specialists in their subject area. How about RBC count? Fig.33). a transform fault is quizlet; chatfield reservoir fishing report; kenny chesney and pink live performance What are the functions of hydrochloric acid in the digestive system? Dr. Lorraine also explains to Mr. Volpe that H. pylori impair All rights reserved. Some of those mechanisms are large amounts of mucus and alkaline secretions, as well as water from the pancreas and gallbladder. This protects the lining of the duodenum from the acidic content of the chyme arriving from the stomach. The duodenum is affected by disorders or disease that may be acute (short-term and severe) or chronic (long-term). The duodenum serves as a buffer zone between the stomach and the jejunum. When calculating percentage of time with pH<4, the same difference in acidity was apparent, 70.0% (19.992.0) and 13.0% (0.034.6), respectively, p<0.01. We have used the wireless BRAVO system to study the buffering effect of the duodenal bulb in duodenal switch (DS), a procedure in which the gastric sleeve produces a Close Log In. The medication Pepcid that Mr. Volpe took for partial relief of his dyspepsia is called an H2 (histamine) receptor antagonist, or H2 blocker. A change in diet did not seem to help and pharmaceuticals only provided temporary relief. Explain the role of the small intestine in the digestive system. (a) Define pyloric sphincter. What secreted bicarbonate in the duodenum? Describe and illustrate how the histological appearance of the mucosa changes from stomach to duodenum. antigen retrieval was performed using pressure cooking in citrate buffer as described earlier. What is the purpose of the bicarbonate in the duodenum? He describes his pain as gnawing, burning (maybe a 4 out of 10 on a pain scale) and points to the epigastric region of his abdomen. (a) Why proteases are secreted in an inactive state? Finally, the ileal mucosa might be more resilient to acid exposure compared to the jejunum used in RYGBP, although these mechanisms remain to be elucidated. 1. Increases HCl secretion and stimulates contraction of intestinal muscle. Second, the remaining small bowel, carrying bile and pancreatic juice, is anastomosed 1m from the ileocecal valve, resulting in decreased uptake of ingested nutrients. This physiologic effect could explain the low incidence of stomal ulcers. Other common disorders of the duodenum include: Duodenitis can have several different causes, including a Helicobacter pylori infection (H. pylori) that commonlycauses ulcers and inflammation in the stomach and duodenum. Dr. Lorraine also explains to Mr. Volpe that H. pylori impairs the normal buffering effect in his duodenum. Sahin Y. Celiac disease in children: A review of the literature. Discuss the role of digestion and absorption. The duodenums C shape surrounds the pancreas, which provides it with pancreatic enzymes for digestion. Which cells secrete bicarbonate in the duodenum? Also, see the different parts of the small intestine using a diagram. (a) Define pepsin. What are the key symptoms for Helicobacter pylori? Placement of the Bravo wireless pH monitoring capsule onto the gastric wall underendoscopic guidance. There was no significant difference in registration time pre- and postpylorically (17.2 vs. 23.1, p=0.36). Total registration time was 17.2 (1.324) hours prepyloric and 23.1 (1.224) hours postpyloric, with a corresponding pH of 2.66 (1.745.81) and 5.79 (4.757.58), p<0.01. 30 Accesses. Caparello C, Bravi I, Cant P, Grigolon A, Tenca A, Mauro A, et al. Describe the process of bile emulsification of lipids and how it improves lipase activity. The incidence of marginal ulcer ranges between 0.6 and 16% after RYGBP [5, 6], while it is substantially less frequent in patients having had DS around 0.3% [4]. The physiological basis of this barrier function involves several factors and mechanisms. 1. Dr. Lorraine also explains to Mr. Volpe thatH. The duodenum submucosal glands secret large amount of mucus and urogastrone. The wireless pH recording was activated and patients were asked to carry the portable receiver in a band over the shoulder. Bethesda, MD 20894, Web Policies This physiologic HCO protects the mucosa from acid-related injury by a combination of luminal neutralization of H + and by buffering H + in the epithelial cells and possibly the interstitium. IntroductionBariatric procedures result in massive weight loss, however, not without side effects. The total registration time before the detachment of the capsule, median pH during the total registration time, percentage of time with pH<4, as well as pH 30min immediately before and during meals, were registered. Physicians should be aware of these serious adverse effects particularly when administering mycophenolate mofetil to patients with a gastrointestinal disease. Sal has a duodenal ulcer and infection with the bacterium Helicobacter pylori (H. pylori). The bicarbonate buffer system is an acid-base homeostatic mechanism involving the balance of carbonic acid (H 2 CO 3), bicarbonate ion (HCO 3), and carbon dioxide (CO 2) in order to maintain pH in the blood and duodenum, among other tissues, to support proper metabolic function. Moreover, the mucus is known to have a protective effect against the erosive acidic gastric content on the underlying endothelium [21, 22]. Explain the stimulatory and inhibitory events/activities that can influence the activity of the stomach and intestines. Describe the process of gastric digestion. The lumen of the duodenum secretes bicarbonate to protect against the HCl in the chyme going through the duodenum. Click the card to flip Definition 1 / 54 1. Describe how the histology of the stomach is unique and the reason for this adaptation. Duodenum also protects itself by secretion of mucus, rich in bicarbonate. What is the buffering effect of the duodenum and how it is accomplished? During fasting, pH is <4 most of the time in a healthy stomach. What cells are involved and what do they secrete? The duodenum has several mechanisms that allow it to counteract highly acidic stomachs. 1974 Nov;50(589):683-8. Patients were asked to eat and drink at their leisure, and to register their meals for the next 24h. All capsules but one could be successfully placed, without complications. Having such a resource contributes to adjustment because persons are less affected by negative life events. Small molecules such as bicarbonate and phosphate provide buffering capacity as do other substances, such as hemoglobin and other proteins. How is the structure (surface area) of the small intestine designed to optimize absorption? (a) Explain peristalsis. Sofi AA, Filipiak C, Sodeman T, Ahmad U, Nawras A, Daboul I. DOI identifier: 10.1007/s11695-017-2574-0. When he eats, he tells Dr. Lorraine, the pain goes away, but then he feels bloated and a little nauseated. [2] The findings of Bayliss and Starling remain as a scientific truth, but . Explain, in detail, how the urine and intracellular phosphate buffer system acts to minimize pH changes. Include organs, hormones, rate-limiting. For example, a buffer can be composed of dissolved HC 2 H 3 O 2 (a weak acid) and NaC 2 H 3 O 2 (the salt derived from that weak acid). Pandolfino JE, Schreiner MA, Lee TJ, Zhang Q, Kahrilas PJ. (a) Define pyloric sphincter. Sound Design Techniques. Explain the relationship between the diaphragm and the gastroesophageal sphincter. Buffering refers to the neutralization of gastric acidity by the bicarbonate present in the pancreatic juice. Email. To make the program work logically, the cout object must empty itself when the message is to appear. What is peristalsis and how is it used in digestion? b) What substances are made in the pancreas, where do they travel to and how do they work in the small intestine? Explain the relationship between the diaphragm and the gastroesophageal sphincter. Why or why not? Our experts can answer your tough homework and study questions. Ambulatory gastric pH monitoring: proper probe placement and normal values. This problem has been solved! We placed a pre- and a postpyloric pH capsule in 15 DS-patients (seven men, 44years, BMI 33) under endoscopic guidance and verified the correct location by fluoroscopy. Catalyzed by carbonic anhydrase, carbon dioxide (CO 2) reacts with water (H 2 O) to form carbonic acid (H 2 CO 3 . Describe the functions of the following components of gastric juice. In this pH-metric study, we could demonstrate that the duodenal bulb has a large buffering effect. Too much acid and inflammation from this infection is causing your pain. Why does digestion have to occur before absorption? The duodenum is the first section of the small intestine in most higher vertebrates, including mammals, reptiles, and birds.In fish, the divisions of the small intestine are not as clear, and the terms anterior intestine or proximal intestine may be used instead of duodenum. The bowel was then stored in 30 ml of intestine solution and stored on ice in a 4 C incubator. The repeated fluoroscopic examinations, directly after placing the capsule and on the following morning, verified the correct placement of the capsules. 7. The duodenum epithelium contains Brunner's glands (also known as the duodenal glands) that secrete mucus rich in bicarbonates. Time of registration, pH, mean percentage of time with pH<4 and difference in pH before and during meals were compared using Wilcoxon matched-pair signed rank test. A healthy duode-nal mucosal epithelium resists this challenge. We call this a biopsy. Duodenum: Anatomy, Location, and Function. 1. (b) What is its function? Ingestion of food increases the intragastric pH as a result of the buffering effect, usually returning to baseline after 2h. We could verify the change in intragastric pH during meals, and in addition, we could demonstrate an increase in postpyloric pH, probably occurring due to increased buffering of ingested food passing into the duodenal bulb. Each segment has a different structure and shape and performs a different function. Two mechanisms of action are postulated for this alkaline buffer effect; inhibition of the release of an inhibitory substance from the duodenal mucosa or release of a humoral stimulating agent. In conclusion, we could demonstrate that the duodenal bulb has a large buffering effect, thus counteracting the large amount of gastric acid passing into the small bowel after duodenal switch. veritas plunge base for rotary tools; pillsbury banana quick bread mix recipes. That means it prevents histamine release. high fats delay stomach emptying and increasing reflux -avoiding larger meals as they increase stomach pressure and therefore reflux -avoid chocolate, decrease caloric intake, avoid coffee, avoid other irritants like alcohol, carbonated beverages, citrus and tomato peptic ulcers

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