GASTRIC FUNCTION TEST

Gastric juice
HCL
PEPSINOGEN
INTRINSIC FACTOR
 HCL SECRETION
 Lumen Co2 + H2O
Blood

CA

H2CO3

k+ k+
ATPase
H+ H++HCO3- HCO3-

Cl- Cl- Cl-

 REGULATION
 NEURAL PHASE :VAGUS

 GASTRIC PHASE : GASTRIN

 INTESTINAL PHASE : GI HORMONES

 ALKALINE TIDE
 CLASSIFICATION
 ANALYSIS OF GASTRIC RESIDUE
 DETERMINATION OF ENZYMES
 FRACTIONAL GASTRIC ANALYSIS
 STIMULATION TESTS
 TUBELESS GASTRIC ANALYSIS
 INDICATIONS

 PEPTIC ULCER
 ZOLLINGER-ELLISON SYNDROME
 POST OPERATIVE
 COMPLETENESS OF VAGOTOMY
 GASTRIC RESIDUE ANALYSIS
 CONTENT OF STOMACH AFTER 12h
FASTING
 NORMAL < 50 ml
 > 100 ml pyloric obstruction
peptic ulcer/ZES

 COLOURLESS, FLUID, SOUR

FREE ACIDITY
 ACIDITY DUE TO FREE HCL
 NORMAL = 10 – 30 mmol/L
 HYPERCHLOROHYDRIA

PEPTIC ULCER
True ACHLOROHYDRIA :
NO HCL SECRETION
PERNICIOUS ANAEMIA
CHRONIC GASTRITIS
CARCINOMA OF STOMACH
FALSE ACHLOROHYDRIA

 ABSENCE OF FREE HCL DUE TO

NEUTRALIZATION BY ALKALINE SUBSTANCES
 INJECTION OF HISTAMINE

HCL SECRETION
ACHYLIA GASTRICA
NO HCL/PEPSIN SECRETION
PERNICIOUS ANAEMIA
GASTRIC CARCINOMA
TOTAL ACIDITY
 ACIDITY DUE TO HCL AND ORGANIC ACIDS
(e.g. lactic acid)
 NORMAL=10- 40 mmol/L
 LACTIC ACID: GASTRIC CARCINOMA
PYLORIC STENOSIS
MUCUS :MALIGNANCY
BLOOD :TRAUMA
ULCER
 PEPSINOGEN

I II
oxyntic glands cardiac/pyloric
glands
20-100µg/L 5-20µg/L
ZES GASTRIC ULCER
PEPTIC ULCER
FRACTIONAL GASTRIC ANALYSIS

TEST MEALS
EWALD MEAL (toast + tea)
RIEGEL MEAL (beef steep + boiled
potato)
Normal Response
Free Acid = 10 – 30 mmol/L
Total Acid = 10 – 40 mmol/L
HISTAMINE STIMULATION TEST
STANDARD HISTAMINE TEST
histamine =0.01mg/kg body wt
AUGMENTED HISTAMINE TEST
histamine =0.04mg/kg body wt
INDICATIONS
1) To differentiate true achlorohydria from
false achlorohydria
2) To asses the maximum possible acid
secretion
3) To show an inability to secrete acid
INTERPRETATION

 NORMAL = 10 – 30 mmol/L
 PEPTIC ULCER = >100 mmol/L
 PERNICIOUS ANAEMIA = 0

ALCOHOL STIMULATION TEST

7% ETHYL ALCOHOL (100 ml)
CAFFEINE STIMULATION TEST
Caffeine sodium benzoate (500 mg)
INSULIN STIMULATION TEST
(HOLLANDER’S TEST)

 INDICATIONS
TO asses the completeness of
vagotomy in patients with peptic ulcer

PRINCIPLE
Insulin(0.1u/kg) hypoglycemia
vagus

Acid secretion
PENTAGASTRIN STIMULATION TEST

 SYNTHETIC PEPTIDE
 6 µg/kg

 BASAL ACID OUTPUT (BAO)

acid output in mmol/hr in the basal

secretion (without stimulation)
MAXIMAL ACID OUTPUT (MAO)
sum of the acid output of the four 15-min
samples after the stimulation
PEAK ACID OUTPUT (PAO)

 Sum of the acid output of the 2

consecutive 15-min samples having the
highest acid content
 INTERPRETATION

normal peptic ulcer ZES

BAO 1–5 5 – 15 >20
MAO 10 – 40 15 - 50 >50
PAO 15 – 50 20 – 60 >60
TUBELESS GASTRIC ANALYSIS

 DIAGNEX BLUE TABLETS

(carbacrylic cation exchange resin
+ azure A)
HCL

Azure A is released and excreted in urine

ZOLLINGER ELLISON SYNDROME

 ISLET CELL TUMOR OF PANCREAS

 GASTRIN HYPERSECRETION
PEPTIC ULCER
DIARRHOEA

LAB DIAGNOSIS
Gastrin, BAO, MAO, PAO