[The value of the rapid pentagastrin test]

The evidence of the pentagastrin rapid test inaugurated by Johnston and Jepson in contrast to the usual analysis of the gastric secretion (DAB 7 GDR) was controlled on altogether 256 patients. Of them 121 patients were examined according to the well-known method and 135 patients with the shortened pentagastrin test. The same efficiency could be verified for the pentagastrin rapid test. The stimulated acid secretion may be sufficiently exactly established with the help of this test for the daily practice and may be recommended for the use in the outpatient practice. The limits of the normal values established up to the existence of a sufficiently large number of test persons, a norm region of 3-25 mmol/h should be taken as a basis.

Antral vascular lesion, achlorhydria, and chronic gastrointestinal blood loss: response to steroids

A 72-year-old female gave a history of chronic gastrointestinal blood loss necessitating transfusion with over 90 units of blood despite continuous oral iron therapy over a period of 24 years. Gastroscopic appearances were very similar to those recently described by Lewis and by Wheeler in patients with submucosal angiomatous lesions and chronic gastrointestinal blood loss. Striking erythematous streaks radiated from the pylorus and were confined to the antrum. In our case complete achlorhydria to pentagastrin was associated with low serum and antral gastrin concentrations. The introduction of oral prednisolone was followed by a marked fall in the rate of gastrointestinal blood loss, removing the need for transfusion during the following year. Complete achlorhydria persisted and endoscopic appearances remained unchanged, but there was a marked rise in antral and serum gastrin concentrations. The possible modes of action of prednisolone in this case are discussed. The patient remains well in November 1979. The dose of prednisolone was reduced to 10 mg on alternate days in May 1979. Iron supplements have been continued but no transfusion has been required since the start of steroid therapy. The hemoglobin has gradually risen to 14.9 g/dl.

Benign gastric ulcer in a patient with betazole-fast achlorhydria

We report a case of benign gastric ulcer that occurred in a 50-year-old man with betazole hydrochloride-fast achlorhydria. The rarity of exceptions to the rule that ulcers in achlorhydric stomachs are malignant (to our knowledge, this is only the sixth reported case) confirms the wisdom of regarding such ulcers as malignant until proved unequivocally to be benign.

Can 99mTc-pertechnetate be used to assess the secretion of gastric acid in pernicious anemia?

The gastric secretion of 99mTc-pertechnetate as a means of assessing parietal cell function was investigated in 12 pernicious anemia (PA) patients with histamine-fast achlorhydria. Twelve control subjects were either normal volunteers or patients proven not to have either PA or any other gastrointestinal disease. The results indicated that, while the stomachs of PA patients secreted no hydrochloric acid, they continued to secrete 99mTc-pertechnetate, indicating that 99mTcO4 - is secreted not by parietal cells alone or else not by parietal cells at all. The gastric pertechnetate activity, therefore, cannot be used as an index of gastric acid secretory activity in PA.

[LDH isoenzymes and gastrin in achlorhydri (author's transl)]

Several haematological findings (especially the values of serum LDH and its isoenzymes) were compared with changes in the gastrin level in pernicious anaemia. While vitamin B12 substitution therapy led to normalization of the anaemia and of the enzyme levels, gastric atrophy and, hence, the elevation in serum gastrin levels remained unchanged. Determination of serum gastrin, therefore, provides a valuable tool for the verification of the diagnosis of pernicious anaemia in treated cases.

Evaluation of a new method for the intragastric titration of gastric juice

A new method for the intragastric titration of hydrochloric acid with a pH sensitive telemetric antimone electrode connected via a receiver to an electronic trigger, which regulates a pump for the inflow of 1 M KHCO3 solution, was evaluated in 22 achlorhydric patients by a series of intragastric instillations of 0.1 N HCl. In vitro this procedure presented a high precision (r = 0.99). Under in vivo conditions a significant correlationship (r = 0.84, p = 0.001) between the input of hydrochloric acid and bicarbonate in a range from 1.4 to 16.7 mEq/30 min could be established in non-operated subjects. The average coefficient of variation was 34%. In subjects with partial gastrectomy (Billroth II) overtitration of 100% (y = 2.1 x -1.7, r = 0.78, p = 0.001) was recorded, suggesting an increased loss of bicarbonate related to the accelerated gastric evacuation.

Watery diarrhoea and hypokalaemia associated with a phaeochromocytoma

The syndrome of water diarrhoea, hypokalaemia and achlorhydria (WDHA) is well described in association with a non-beta islet cell tumour of the pancreas. The following case report is of a 28-year-old woman with a WDHA syndrome that was cured by the removal of a phaeochromocytoma.

Marginal ulcer in achlorhydric patients

Recurrent gastrojejunal ulceration is reported in three patients with histamine-fast achlorhydria. In none of these patients was extruding suture material responsible for the ulceration. However, all three patients had a history of alcohol abuse, and one abused aspirin as well. These cases demonstrate that achlorhydria does not protect against anastomotic ulceration. It is suggested that surgical manipulation produces an increased susceptibility to mucosal damage, and that it is erroneous to consider all anastomotic ulceration as a continuation or recurrence of acid peptic disease.