Citric Acid
| Evidence Level: L5 | Predicted Indications: 8 |
Table of Contents
Citric Acid: Stomach disease
One-Sentence Summary
Citric acid is an organic acid with several marketed single-ingredient products in Canada, including anticoagulant solutions and bowel-preparation products. The TxGNN model predicts it may be relevant to stomach disease, with a score of 0.9974. No clinical trials are registered for this prediction, and no published study tests citric acid as a treatment for it, so the evidence level is L5 (model prediction only).
Quick Overview
| Item | Content |
|---|---|
| Original Indication | Not recorded in the local data |
| Predicted New Indication | Stomach disease |
| TxGNN Prediction Score | 0.9974 |
| Evidence Level | L5 |
| Canada Market Status | Marketed (marketed DINs: 10 of 10) |
| Number of DINs | 10 (marketed: 10) |
| Recommended Decision | Hold |
Why is This Prediction Reasonable?
Detailed mechanism-of-action data for citric acid are not available in the data compiled for this report. Citric acid is a weak organic acid that acts as a buffer and a calcium chelator. This chelation is the basis of its use in anticoagulant citrate solutions.
A plausible, but unproven, link to stomach disease is that citric acid influences gastric acidity and mucosal conditions. This is speculation and has not been tested in a therapeutic study.
The retrieved publications do not close this gap. The closest are studies using a citric acid test meal to improve the accuracy of the 13C-urea breath test for Helicobacter pylori. That is a diagnostic adjunct, not a treatment. The remaining papers cover diet in ulcer disease, H. pylori physiology, gastric cancer biology and unrelated topics. The prediction therefore rests on the model score alone.
Clinical Trial Evidence
Currently no related clinical trials registered.
Literature Evidence
No study directly tests citric acid as a treatment for stomach disease. The most relevant items are listed below.
| PMID | Year | Type | Journal | Key Findings |
|---|---|---|---|---|
| 31505905 | 2019 | Clinical diagnostic study | Gut and Liver | Discusses whether a citric acid meal improves the accuracy of the 13C-urea breath test in Asian populations (diagnostic use only) |
| 30970440 | 2019 | Clinical study | Gut and Liver | Effect of citric acid on 13C-urea breath test accuracy after H. pylori eradication in a region with a high prevalence of atrophic gastritis |
| 15854177 | 2005 | Mechanistic study | Aliment Pharmacol Ther | Compares citric, malic and ascorbic acid effects on intragastric urease activity |
| 2072799 | 1991 | Review | Med Clin North Am | Diet and nutrition in ulcer disease; restrictive diets are not supported |
| 9889978 | 1998 | Review | Adv Microb Physiol | Physiology and metabolism of the gastric pathogen H. pylori |
| 35900644 | 2022 | Cohort | Metabolomics | Higher serum citric acid is detectable in Koreans before gastric cancer onset (biomarker finding) |
Canada Market Information
| DIN | Product Name | Dosage Form | Approved Indication |
|---|---|---|---|
| 02469731 | Anticoagulant Citrate Dextrose Solution USP (ACD) Formula A | Not listed | Not listed |
| 02317966 | PURG-ODAN | Not listed | Not listed |
| 00788139 | Anticoagulant Citrate Dextrose Solution USP (ACD) Formula A | Not listed | Not listed |
| 02254794 | PICO-SALAX | Not listed | Not listed |
| 01935941 | Heparin Sodium in 5% Dextrose Injection, 25000 unit/500 mL | Not listed | Not listed |
All 10 licences on record are valid licences. Only five are shown here.
Safety Considerations
- Drug Interactions: 15 interactions were identified. The one rated Major is aluminum hydroxide. The other 14 are rated Moderate and are mostly fluoroquinolone and related antibiotics, including ciprofloxacin, levofloxacin, moxifloxacin, ofloxacin, norfloxacin, enoxacin, gatifloxacin, gemifloxacin, lomefloxacin, sparfloxacin, trovafloxacin, grepafloxacin, nalidixic acid and cinoxacin.
Please refer to the package insert for warnings and contraindications.
Conclusion and Next Steps
Decision: Hold
Rationale: The prediction score is high (0.9974), but no clinical trial exists and no published study tests citric acid as a treatment for stomach disease. The evidence level is therefore L5. The retrieved literature is limited to diagnostic and background studies.
To proceed, the following is needed:
- Mechanism-of-action data for citric acid
- Package insert warnings and contraindications from Health Canada
- Preclinical or early clinical studies testing citric acid directly in a defined gastric condition
- A safety review of the interaction with aluminum hydroxide and of the fluoroquinolone interactions
Disclaimer
This content is for research purposes only and does not constitute medical advice. Clinical validation is required before any clinical application.