Gastric analysis

Gastric juice:- mixture of secretions

Secreted by two main types of cells in gastric mucosa
• Parietal cell:- also known as oxyntic cells- secretes HCL and Intrinsic factor
• Non- Parietal cells:- comprise of peptic(chief) cells- secretes pepsinogen which is activated by presence
of HCL to pepsin for the digestion of protein
Composition of Gastric juice
• Acids: - Free acid (HCL) and combined acid ( organic acids lactic and butyric acid)
• Mucus acts as buffering system by neutralizing HCL & prevents corrosion of mucous membrane
• Enzymes:- Pepsinogen, Renin and lipase
• Intrinsic factor:- hemopoietic factor deficiency leads to pernicious anaemia
• Electrolytes : -sodium, Potassium and chlorides

Secretion of gastric juice

Secreted in response to sight, smell, thought, taste of appetizing food or Gastrin (hormone secreted by gastric
Mucosa)

Stimulation of Gastric secretion

Secretion is increased y use of either Oral or Parenteral stimulants
Oral Stimulants
• Tea without milk
• Toast without butter
• Dilute alcohol (7%)
• Porridge
Parenteral stimulants
• Histamine local hormone
• Pentagastrin synthetic product of gastrin
• Insulin physiological hormone
Disadvantages of Oral Stimulants
• Failure to give maximum stimulation
• Failure to give consistent results
• Difficult in aspirating secretion due to tube blockage when porridge is used
Advantages Parenteral stimulants
• Gives maximum stimulation
• Gives consistent results
• Less chance of tube blockage during aspiration.

Terminology and diagnosis based on acid content in gastric secretions

Achlorhydria: - Also referred to anacidity- complete absence of acid in gastric secretion. May be due to
pernicious anaemia
Hypochlorydria:- Also referred to as hypoacidity decrease in acid secretion. May be due to gastric ulcers,
Gastric carcinoma and chronic gastritis.
Hyperchlorydria: - referred to as hyperacidity- increase in acid secretion. May be due to duodenal ulcers.

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 Simple analysis of fasting juice
Volume: - Normal 20-50ml: Volume increases due to pyloric obstruction
Mucus: - Little; increase may be due to swallowed saliva, gastritis and gastric carcinoma.
Bile:- Nil: presence may be due to flow-back (regurgitation)of bile from the duodenum
Or passage of tube in the duodenum
Starch:- Nil or very little; presence may indicate impaired digestion of carbohydrate or obstruction.
Blood: - Nil: presence indicates esophageal or intra-gastric bleeding or trauma (bleeding) caused by passage of the
tube.
Augmented Histamine Test

Purpose of the test:

(a) To assess maximum possible acid output in the diagnosis and surgical treatment of duodenal ulcers
(b) To detect complete absence of acid secretion (anacidity) in cases of pernicious anaemia

Requirements
• Suction tube/syringe for aspiration
• Stomach tube (Levin, Ryles or Rehfuss)
• Screw-capped bottles label them as: Fasting, Basal, Histamine I,II,III,IV
• Histamine Injection
• Antihistamine injection
Procedure
• Patient fasts for 12 hrs
• Pass stomach tube via mouth or nose into the stomach(caution the patient not to swallow saliva)
• Aspirate fasting gastric juice and label it Fasting
• Aspirate spontaneously secreted juice for the next 60min and label it Basal
• Inject the patient Intramuscularly with antihistamine (10mg chlorpheniramine maleate or 50mg
diphenhydramine hydrochloride)
• Aspirate gastric juice for the next 30min and discard this specimen
• Inject the patient subcutaneously with Histamine (dose based on Kg. body wt.) e.g 0.04mg/kg/wt
• Aspirate Histamine stimulated secretion as :

0-15min Label Histamin I

15-30min- Label Histamine II

30-45min- Label Histamine III

45-60min- Label Histamine IV
• Withdraw the tube and the specimens are now ready for biochemical analysis
• Analyze the acid content by titration
Interpretation
The upper limit of normal is 30mEq HCL secreted in 30min period between 15-45min after histamine injection
Values higher than above is seen in duodenal ulcers and Zollinger Ellison syndrome

Pentagastrin test

Almost the same as augmented histamine test

Results obtained by the two are comparable
Advantages of Pentagastrin test over Augmented histamine test

Very small amount of injection is used

Patients do not react to this injection

It takes shorter time

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 Requirements
• Suction tube/syringe for aspiration
• Stomach tube (Levin, Ryles or Rehfuss)
• Screw-capped bottles label them as: Fasting, Basal I & II, Gastrin I,II,III,IV
• Pentagastrin( I.C.I)
Procedure
• Patient fasts for 12 hrs
• Pass stomach tube via mouth or nose into the stomach(caution the patient not to swallow saliva)
• Aspirate Basal I for the next 15min
• Aspirate Basal II for the next 15 min
• Inject intramuscularly with Pentagastrin ( I.C.I)-dose based on Kg. body wt.
• Continuously aspirate gastrin stimulated secretions as follows;

0-15min Label Gastrin I

15-30min- Label Gastrin II

30-45min- Label Gastrin III

45-60min- Label Gastrin IV
• Withdraw the tube and the specimens are now ready for biochemical analysis
• Analyze the acid content by titration

Histamine Infusion Test

The use of a slow I/V infusion of histamine allows measurement of acid output in a sustained steady state

Advantages
• It obviates the need for doing basal and augmented histamine tests
• The greater acid output achieved in sustained steady state facilitates the detection of low levels acid output
• This is a highly reproducible test
• The slow histamine infusion has lesser side effect
Method
1) Patient is intubated following a 12hr overnight fast
2) Basal hour collection is obtained
3) 30 min before completion of the basal hour, a suitable dose of antihistamine is given intramuscularly
4) After completion of the basal hour, an I/V infusion of histamine in physiological saline is begun and the
dose rate is adjusted to deliver 0.04mg of histamine phosphate per kg body weight/hr
5) The infusion is continued until four 15min steady state samples have been collected.
6) Each sample of the basal hour and steady state is analyzed for vol., pH and titrable acidity.

Interpretation
7) The normal values of acid output in mEq/hr for males is 16-32 and for females is 18-25.
8) The values are markedly higher in duodenal ulcer patients

Barium meal
A meal containing barium sulphate salt which is a radio-opague compound for the demonstration of the
anatomical defect of the stomach and the intestines for the radiological study of the shapes and peristaltic
movements of these organs. This is followed by X-ray photographs. This is performed in the diagnosis of ulcers
in the stomach and the intestines.

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