Year: 2026
Type: article
Study design: Observational Study
Abstract: Background Physiological evidence indicates that systemic acid-base balance may be associated with gastric acid secretion, which is a key factor in peptic ulcers disease (PUD). However, the epidemiological relationship of this association with PUD risk remains unclear. Aim This study investigates a novel corrected anion gap (AG corr , reflecting metabolic acid load) and bicarbonate (HCO₃ − , reflecting alkaline reserve) in relation to PUD. Methods This retrospective case-control study analyzed endoscopy-confirmed 64 PUD patients and 541 non-PUD controls with normal hepatic and renal function from a Fujian tertiary hospital (Jan 2023–Jun 2025). The anion gap (AG) was corrected to fully-corrected AG corr and albumin-corrected AG (ACAG). Four models (A: AG corr ; B: HCO₃ − ; C: AG; D: ACAG) were adjusted for sex, age, and Na to study the relationships between AG corr , ACAG, AG, HCO 3 , and PUD. Post-hoc power and sensitivity analysis were conducted. Results Model A showed that AG corr was significantly positively associated with PUD risk (OR = 1.167, 95% CI: 1.050–1.298, P = 0.045), with a high statistical power of 89%. Sensitivity analysis with an expanded control group ( n = 1915) confirmed a significant AG corr -PUD association (OR = 1.138, 95% CI: 1.029–1.259, P = 0.012), with post hoc power of 0.81. The sensitivity analysis with case-control matching for sex and age showed that AG corr remained significantly associated with PUD ( P = 0.020). In contrast, Model C and Model D were both significantly correlated ( P < 0.05) but showed poor fit (H-L P < 0.05). However, their statistical power differed, with values of only 0.64 and 0.84, respectively. Model B indicated a negative correlation between PUD and HCO₃ − (OR = 0.894, 95% CI: 0.802–0.996, P = 0.043), but with low statistical power (65%) and instability in sensitivity analysis. Conclusion After adjusting for sex, age, and Na, AG corr remained an independent risk factor for PUD in individuals with normal liver and kidney function. The fully-corrected AG outperformed both ACAG and uncorrected AG. Metabolic non-volatile acid attack may be an important pathogenic mechanism in PUD. HCO₃ − may have a potential protective effect against PUD. The findings contribute to improving PUD care but require further validation in diverse groups.
Source: Frontiers in Nutrition
Authors: Xian-Ping Lin, Song-Xing Lin
Institution: Putian University
Language: English
Subfield: Nephrology
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $3,801
Funder: Putian University
OpenAlex ID: W7123674235