This document discusses various tests used to evaluate gastric secretion and function. It describes tests such as basal acid output, maximal acid output, peak acid output and their results in different conditions like Zollinger-Ellison syndrome. Stimulation tests using substances like pentagastrin, histamine, insulin and ethanol are explained. Tests for H. pylori infection, gastric emptying and vitamin B12 absorption are also summarized. The document provides details of different gastric function tests, their procedures, and clinical significance.

1. Dr. S.Sethupathy

2.  After overnight, 20-50- ml
 More than 100-120 ml – abnormal volume
 Causes: hypersecretion of acid
 Retention due to pyloric obstruction
 Regurgitation from duodenum
 Consistency- fluid No food particles
 Clear
 Red/dark red/ brown- ulcer ,bleeding
 Coffee ground – ca.stomach

3.  Bile- reflux gastritis
 Mucus- carcinoma stomach
 Free acid- 0-30 mmol/L
 More than 50 mmol/L – hyperacidity
 Total acid – 10- 40 mmol/L
 Organic acids- achlorhydria , hypochlorhydria

4.  Cancer stomach
 Perinicious anaemia
 Advanced gastritis
 No acid – to investigate

5.  Two pieces of toast and tea or oat meal
porridge
 Residual content removed before meal
 Gastric juice collected at intervals
 Free acid more than 50 mmol/L –
duodenal,gastric ulcer, Zollinger Ellison
syndrome, Pyloric stenosis, ch.cholecystitis

6.  7% ethanol stimulation 100 ml
 Overnight fast , residual contents removed
 Sample every 15 mins
 Total and free acidity
 Easy to administer than oat meal
 Rapid and gastric emptying is better
 Unphysiological and free acid is more
 Caffeine S.Test -500mg in 200 ml - similar
to alcohol stimulation

7.  Pentragastrin is a pentapeptide having the
same terminal sequence of four amino acids
- as gastrin
 It is butyl oxy carbonyl-beta alanine-Trp-
Met-Asp-Phe-CONH2
 BAO, MAO, PAO are increased in Zollinger
Ellison syndrome.
 In atrophic gastritis, pernicious anemia and
gastric carcinoma, there is achlorhydria.

8.  Histamine is a potent stimulus of gastric
secretion
 test is done by giving 0.04 mg/kg histamine
s.c.
 Histamine fast achlorhydria is due to
pernicious anemia.
 Hypotension.
 Antihistamine to block H1 receptor effects of
histamine.
 Cimetidine, a H2 histamine receptor blocker
is used in peptic ulcer.

9.  Histamine analog – Histalog
 3-beta amino ethyl pyrazole
 10-50- mg
 No side effects

10.  Insulin stimulates HCl secretion
 Duodenal ulcer
 Hypoglycemia
 15 units soluble iv

11.  Basal acid output (BAO) is less than 10
mmol/hour in males and less than 5.5
mmol/hour in females.
 It is increased (more than 15 mmol/hour) in
Zollinger Ellison syndrome.
 Maximal acid output (MAO) is 7-45
mmol/hour and is after stimulation.
 Peak acid output (PAO) after stimulation is
12-60 mmol/hour.

13.  It is increased in gastrinoma, Zollinger
Ellison syndrome.
 Moderate elevation of gastrin is also seen in
pernicious anemia, hyper secretion of gastrin
by antral G cells and renal failure, proton
pump inhibitors intake.
 After secretin , serum gastrin level increases
in ZES but not in other conditions.

14.  Condition serum gastrin (pg/ml)
 Normal < 500
 Antral gastritis low to normal
 Duodenal ulcer 300 - 500
 Fundal gastritis 300 - 60,000
 Z.E. syndrome3,500 - 60,000

15.  Pancreatic gastrin producing cells(Common)
 Gastric gastrin producing cells
 Peptic ulcer, diarrhea, steatorrhea
 Fasting serum gastrin- >1000pg/mL
 Secretin test- 2,5,10,15,20 mins –difference
> 200pg/mL

16.  Gastric secretion is stimulated and after one
hour, a dye bound to resin (Azure-A) is given
orally.
 Based on the surrounding pH, the resin
releases the dye
 It is absorbed and excreted in urine.
 The quantity of dye in urine indicates the
acidity of gastric juice. It rules out
achlorhydria.
 It is used as a screening test.

17.  H.pylori infection is playing a role in acid
peptic disease.
 Urease enzyme
 The presence of urease- pyloric infection.
 Urea breath test
 13 C, 14 C- urea
 Breath CO2
 Serological tests – less reliable

18.  Vitamin B12 deficiency is macrocytic anemia and
c megaloblastic
 Low serum vitamin B12 concentrations
 Pernicious anemia –intrinsic factor deficiency or
to intestinal malabsorption or dietary deficiency.
 The test involves - two orally administered test
doses of radioactive labelled vitamin B12
 Measuring radioactivity in a urine specimen
collected for five hours.
 The first test dose -alone
 The 2nd test dose - three days later) - with
intrinsic factor.

19. Condition
Results
1st Stage 2nd Stage
normal absorption absorption
dietary
deficiency
absorption absorption
intestinal
disease
malabsorption malabsorption
pernicious
anemia
malabsorption absorption

20.  Limited but specific uses in certain conditions
 Perinicious anaemia
 ZES
 Peptic ulcer
 Now endoscopy plays a major role
 Biopsy can be taken

21. Thank YOU