Examination of gastric contents

General clinical examination of gastric contents

Gastric juice is a secretion of glands located in the gastric mucosa; it participates in the complex process of digestion and is secreted 5-10 minutes after eating. Outside of digestion, gastric juice is not secreted. The study of gastric juice is important for assessing the functional state of the stomach. It includes the study of physicochemical properties and microscopic examination. The main method of functional study of gastric secretion is fractional probing using a gastric secretion stimulator (test breakfast). The essence of the method is that after inserting the probe into the stomach, the entire contents of the stomach are removed - a portion on an empty stomach; then 4 portions of gastric juice are collected in a separate container every 15 minutes. The irritant in this case is the probe inserted into the stomach (the first phase of secretion or basal secretion); then a food irritant (cabbage juice or meat broth, "alcoholic" or "caffeine" breakfast) is introduced into the stomach through the probe. Ten minutes after the introduction of the food stimulus, 10 ml of gastric contents are extracted, and after another 15 minutes, the entire contents of the stomach are pumped out - the remainder of the test breakfast. Subsequently, for an hour, every 15 minutes, all gastric contents are extracted into separate cups (second phase of secretion or stimulated secretion).

Gastric content indices

Color. Normally, gastric juice is yellowish-white. Blood impurities give gastric juice various shades of red: with fresh bleeding - scarlet, if the blood has been in the stomach for a long time - brown. Bile gives gastric juice a green color, since bilirubin in bile turns into biliverdin. With achylia, biliverdin is not formed and gastric juice with bile impurities has a yellow tint.

Smell. Normally, gastric juice has no odor. A putrid odor appears with hyposecretion or absence of hydrochloric acid, stagnation and fermentation of the stomach contents, stenosis, tumor decay, protein decay. In the absence of hydrochloric acid, the smell of organic acids may appear - acetic, lactic, butyric.

Volume of gastric juice. The volume of fasting contents, the volume of basal secretion, the volume of gastric contents extracted 25 minutes after the test breakfast (residue), and the hourly secretion tension are determined. The hourly tension is the volume of gastric juice secreted in 1 hour. For example, the hourly tension of phase I secretion is the sum of the volumes of the 2nd, 3rd, 4th, and 5th portions after the introduction of the tube (without the test breakfast). The hourly tension of phase II secretion is the sum of the volumes of the 8th, 9th, 10th, and 11th portions or the 3rd, 4th, 5th, and 6th portions after the introduction of the test breakfast.

Acidity. To judge the acid-forming function of the stomach, a number of indicators are determined.

• Total acidity is the sum of all acidic products contained in gastric juice: free and bound hydrochloric acid, organic acids, acid phosphates and sulfates.
• Bound hydrochloric acid is the undissociated hydrochloric acid of protein-hydrochloric acid complexes in gastric juice; in gastritis, bleeding ulcers, and tumor disintegration, the amount of proteins in the stomach increases, and the content of bound hydrochloric acid may also increase.
• Free hydrochloric acid is dissociated into H ⁺ and CL- ^ions.
• Hydrochloric acid flow rate is the absolute amount of hydrochloric acid released over a certain period of time.
• Acid residue - all acidic components of gastric juice except hydrochloric acid, that is, acidic salts and organic acids.

Reference values for gastric secretion

Gastric secretion	Acidity, titration units		HCl flow rate, mmol/h	Free HCl flow rate, mmol/h	Volume of gastric contents, ml
	Total HCl	Free HCl
On an empty stomach	Up to 40	Up to 20	Up to 2	Up to 1	Up to 50
Basal stimulation (Phase I)	40-60	20-40	1.5-5.5	1-4	Hourly secretion voltage - 50-100
Leporsky stimulation (Phase II)	40-60	20-40	1.5-6	1-4.5	Remaining up to 75. Hourly secretion voltage - 50-110

Pepsin concentration. Reference values for pepsin concentration determined by Tugolukov's method are: on an empty stomach 0-21 g/l, after a test cabbage breakfast - 20-40 g/l. Pepsin concentration is an important indicator in the diagnosis of achylia - a condition in which hydrochloric acid and pepsin are absent from the gastric juice. Achylia can be detected in Addison-Birmer anemia, which is not typical of other forms of vitamin B12 _- deficiency anemia. Achylia, accompanying a special form of gastritis - rigid gastritis, requires additional studies to exclude stomach cancer.

In clinical practice, unstimulated (basal) and stimulated gastric secretion are studied. Enteral (cabbage broth, meat broth, alcoholic breakfast) and parenteral (gastrin and its synthetic analogues, such as pentagastrin, histamine) stimulants are used as stimulants.

Histamine-stimulated gastric secretion indices

Histamine is one of the strongest stimulants of gastric secretion, causing submaximal and maximal histamine secretion depending on the dose. A direct relationship has been noted between the mass of functioning parietal cells and the flow rate of hydrochloric acid after maximal histamine stimulation. A decrease in the number of functioning parietal cells is reflected accordingly in the volume of acid secretion. Histamine is used to differentiate organic achlorhydria, which depends on atrophic changes in the gastric mucosa, and functional achlorhydria, which is associated with inhibition of gastric secretion.

Reference values (norm) of the main indicators of basal, submaximal and maximum gastric secretion during histamine stimulation

Key indicators		Gastric secretion
Gastric secretions	Basal	Submaximal	Maximum
Volume of gastric juice, ml/h	50-100	100-140	180-120
Total acidity, titration units	40-60	80-100	100-120
Free HCL, titration units	20-40	65-85	90-110
Acid production (HCL flow rate), mmol/h	1.5-5.5	8-14	18-26
Pepsin according to Tugolukov:
Concentration, mg%	20-40	50-65	50-75
Flow rate, mg/h	10-40	50-90	90-160

If hydrochloric acid is detected in the gastric juice during a histamine stimulation study, then achlorhydria previously detected by probing without the use of histamine is considered functional. In organic achlorhydria, free hydrochloric acid does not appear after the introduction of histamine. Organic achlorhydria is accompanied by Addison-Birmer anemia, atrophic gastritis and gastric cancer. Functional achlorhydria is possible in many pathological processes accompanied by inhibition of gastric secretion, in some cases it can be a reaction to the probing itself.

Simple and double histamine tests (subcutaneous administration of histamine hydrochloride solution at a dose of 0.08 ml/kg) are methods of submaximal stimulation of gastric secretion. For the maximum histamine test of Kaye, a solution of histamine dihydrochloride is administered subcutaneously at a rate of 0.024 mg/kg. 30 minutes before the administration of histamine, 2 ml of a 2% solution of chloropyramine is administered to prevent the toxic effect of histamine.

Microscopic examination. A portion of gastric juice obtained on an empty stomach is examined microscopically: normally, leukocyte nuclei and a small number of epithelial cells are found. A large number of intact leukocytes and epithelial cells is characteristic of achlorhydria. Single erythrocytes may appear in gastric juice as a result of trauma to the gastric mucosa by a probe. A significant number of erythrocytes may be detected in gastric ulcers and ulcerated gastric cancer.

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