Citric Acid
| Evidence Level: L5 | Predicted Indications: 8 |
Table of Contents
Citric Acid: Weak organic acid, gastric pH modulator → stomach disease
One-Sentence Summary
Citric acid is a weak organic acid that modulates gastric pH and has been used in gastrointestinal settings. The TxGNN model predicts it may be relevant for stomach disease, but the data compiled for this report show 0 clinical trials and 20 publications, none of which show that citric acid treats a gastric disease.
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 |
| India Market Status | Listed in a compiled Indian medicine price dataset (at least 20) – CDSCO approval status is not included in this data |
| Number of Listed Products | at least 20 |
| Recommended Decision | Hold |
Why is This Prediction Reasonable?
Detailed mechanism of action data is not available. Based on general pharmacology, citric acid is a weak organic acid that can influence gastric pH, which gives it a plausible link to the stomach.
The retrieved literature connects citric acid to the stomach only indirectly. One line of work studied a citric acid test meal to improve the accuracy of the 13C-urea breath test for detecting Helicobacter pylori. Another line consists of general reviews on diet in ulcer disease and on H. pylori metabolism. None of these papers tests citric acid as a treatment for a gastric disease.
The very high TxGNN score is a computational output. It should be read as a hypothesis to test, not as evidence of benefit.
Clinical Trial Evidence
Currently no related clinical trials registered.
Literature Evidence
| PMID | Year | Type | Journal | Key Findings |
|---|---|---|---|---|
| 31505905 | 2019 | Diagnostic study | Gut and Liver | Discusses whether a citric acid meal improves 13C-urea breath test accuracy in Asian populations |
| 30970440 | 2019 | Diagnostic study | Gut and Liver | Effect of citric acid on 13C-urea breath test accuracy after H. pylori eradication in a region with common atrophic gastritis |
| 15854177 | 2005 | Clinical study | Aliment Pharmacol Ther | Effect of citric, malic and ascorbic acids on intragastric urease activity |
| 2072799 | 1991 | Review | Med Clin North Am | Diet in ulcer disease; restrictive diets are not supported in the H2-inhibitor era |
| 9889978 | 1998 | Review | Adv Microb Physiol | Physiology and metabolism of H. pylori |
| 35900644 | 2022 | Cohort/metabolomic | Metabolomics | High serum citric acid and L-carnitine detected in Koreans before gastric cancer onset (biomarker association) |
| 22313115 | 2012 | Laboratory study | J Agric Food Chem | Beer bitter acids and mechanisms of gastric acid secretion |
| 7106518 | 1982 | Observational | Gastroenterology | Salivary secretion in reflux oesophagitis |
None of these publications tests citric acid as a therapy for stomach disease.
India Market Information
| Authorization Number | Product Name | Dosage Form | Approved Indication |
|---|---|---|---|
| 123961 | Lupihist Plus Syrup | Syrup, 100 ml bottle | Not recorded |
| 183137 | Quit Expectorant | Expectorant, 100 ml bottle | Not recorded |
| 21827 | Ableed Lotion | Lotion, 60 ml bottle | Not recorded |
| 116037 | Khasigo Syrup | Syrup, 100 ml bottle | Not recorded |
| 77176 | Epharyl Syrup | Syrup, 100 ml bottle | Not recorded |
The local records are partial, so this list may be incomplete. All listed licences are valid.
Safety Considerations
- Drug Interactions: 15 interactions were found. Aluminum hydroxide is rated Major. The other 14 are rated Moderate and are all quinolone antibiotics: cinoxacin, ciprofloxacin, enoxacin, gatifloxacin, gemifloxacin, levofloxacin, lomefloxacin, moxifloxacin, nalidixic acid, norfloxacin, ofloxacin, trovafloxacin, grepafloxacin and sparfloxacin.
Package insert warnings and contraindications are not available in the data compiled for this report. Please refer to the package insert for them.
Conclusion and Next Steps
Decision: Hold
Rationale: No clinical trial or publication tests citric acid as a treatment for stomach disease, so the evidence level is L5. The high TxGNN score of 0.9974 is a computational prediction, and the retrieved papers touch on diagnostic testing and background physiology only.
To proceed, the following is needed:
- Mechanism of action data for citric acid
- Package insert warnings and contraindications from the India regulatory source
- Studies that directly test citric acid for a defined gastric condition
- A clear definition of the target condition, since “stomach disease” is broad
- Review of the interaction with aluminum hydroxide, a common antacid, and with quinolone antibiotics
Disclaimer
This content is for research purposes only and does not constitute medical advice. Clinical validation is required before any clinical application.