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Changes in gastric contents in diseases
Medical expert of the article
Last reviewed: 06.07.2025
The amount of gastric contents may increase with peptic ulcer disease and hyperacid gastritis; a reflex increase may be observed during attacks of acute appendicitis and acute cholecystitis. A decrease in the amount of gastric juice is observed with accelerated emptying of the stomach and with decreased secretion.
Mucus is found in significant quantities in gastritis and peptic ulcer disease, and with leukocytes or their nuclei, cylindrical epithelial cells, and hydrochloric acid hematin deposits - in organic lesions of the mucous membrane, gastritis, peptic ulcer disease, polyposis, and cancer.
An increase in the concentration of pepsin in gastric juice is characteristic of gastric ulcer and duodenal ulcer, hyperthyroidism, and diabetes mellitus. A decrease or complete absence of pepsin in gastric juice is detected in atrophic gastritis, pernicious anemia, hyperthyroidism, Addison's disease, and intoxications.
The concentration of free hydrochloric acid decreases with hypoacid gastritis. Complete absence of free hydrochloric acid (achlorhydria) is detected in chronic anacid gastritis, gastric neoplasms, intoxications, and infectious diseases. In the absence of free hydrochloric acid, it is advisable to determine the presence and amount of bound hydrochloric acid to determine the degree of achlorhydria. In the absence of free but the presence of bound hydrochloric acid, relative achlorhydria is stated; in the absence of both, absolute achlorhydria. The absence of hydrochloric acid and pepsin in the gastric contents is called achylia. Achylia is possible with chronic atrophic gastritis, malignant neoplasms, Addison-Birmer anemia, infectious diseases, intoxications, diabetes mellitus, hypovitaminosis (rare).
An increase in the concentration of free hydrochloric acid is detected in chronic hyperacid gastritis, gastric ulcer and duodenal ulcer.
The amount of bound hydrochloric acid increases with an increase in the amount of substrates in the stomach for its binding (food, pus, mucus, blood, tissue decay), that is, with congestion, inflammation, tumors, etc.
Changes in microscopic examination. During microscopic examination of gastric contents, elements of stagnation, elements of inflammation and elements of atypia are distinguished.
Stagnant gastric juice, in which lactic acid is formed (the result of the activity of lactic acid fermentation bacilli or the product of cancer tumor metabolism), is accompanied by the appearance of plant fiber (undigested and digestible), fat, sarcins, yeast fungi, epithelium, leukocytes, and erythrocytes. Lactic acid fermentation bacilli usually appear in the absence of free hydrochloric acid. An increase in the number of goblet cells, especially in the area of the gastrointestinal anastomosis, is a sign of gastritis. Sharply expressed atypia of epithelial cells (proliferation with pronounced atypia) is characteristic of the initial stage of malignant growth. In the diagnosis of adenocarcinoma, nuclear polymorphism and nuclear atypia are important, which are also detected in solid cancer, colloid cancer, poorly differentiated or undifferentiated gastric cancer.
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