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Objectives of study.
This is an irregularly shaped, distended part of the alimentary canal. Although there is no well-
defined muscular structure in the region where the esophagus joins the stomach, a cardiac
sphincter is present at the entrance of the stomach. The region is normally contracted during
rest, which prevents the escape of gastric juice into the esophagus.
The stomach lies slightly to the left side in the upper portion of the abdomen, just beneath the
ribs and just below the diaphragm which separates the abdominal and thoracic cavities.
Pepsin
Pepsinogen which is an inactive form has a molecular weight of 42,500. It is activated to pepsin,
molecular weight 35,000 and also by HCl. Pepsin itself can catalyze the formation of additional
pepsin from pepsinogen. There are two groups of pepsin viz pepsin I and II. The strongest
stimulant for the secretion of pepsin is acetylcholine. Apart from converting pepsinogen to
pepsin, the acid can also trigger a local cholinergic reflex that stimulates the chief cells to
secrete pepsin. Secretion also stimulates pepsinogen secretion. Pepsin secretion also results
from gastrin infusion. Pepsin is secreted from chief cells.
Mucus
The surface mucous cells secrete visible or insoluble mucus in response to chemical stimulants
such as ethanol and in response to physical contact and friction with roughage in the diet.
Visible mucus is secreted as a gel. It protects the mucosa. During the response to a meal,
insoluble mucus protects the mucosa from physical and chemical damage. It neutralizes a
certain amount of acid and prevents pepsin from coming into contact with the mucosa.
Intrinsic Factor
This is a muco-protein with a molecular weight of 55,000 secreted by the parietal cells. It forms
a complex with vitamin B₁₂ in the stomach so that the vitamin can be absorbed at the terminal
ileum.
Failure to secrete intrinsic factor is associated with achlorhydria and the absence of parietal
cells. The result is vitamin B₁₂ deficiency or pernicious anemia.
1. Neural Phase
This is made up of the reflexes viz unconditioned and conditioned reflexes. With food in the
mouth, nerve impulses from the taste buds pass to the brainstem and trigger the vagal nuclei
to send impulses to the stomach to secrete. Here acetylcholine and gastrin are released and 50-
150ml of juice is produced as a result. This serves as an ignition juice to initiate digestion of
proteins. This is the unconditioned reflex.
(Condition) Emotions (anger, aggression), sight and smell also contribute to the afferent limb
of the reflex. The efferent limb in each case is the vagus (X). Its cholinergic action releases
gastrin. It also acts directly on the parietal cells to release hydrochloric acid and to sensitize
them to gastrin.
2. Gastric (Local) Phase
This is caused by gastrin. The presence of food in the stomach accelerates the increase in gastric
secretion produced by the sight and smell of food and presence of food in the mouth.
Receptors in the walls of the stomach respond to the stretch and chemical stimuli, mainly
amino acids. As a result of stretch (brought about by local reflexes) gastrin is produced. The
gastrin passes into the venous drainage of the stomach from where it travels to all parts of the
body and finally stimulates of juice rich in acid. About 600-750mls of gastric juice is produced.
3. Intestinal Phase
As food enters the duodenum from the stomach a hormone is released. In man the proximal
duodenum is rich in gastrin. The intestinal stimuli result in much less acid secretion than stimuli
from either of the two other phases. Inhibition of gastric motility and hydrochloric acid
secretin also occur when acid and dietary fats reach the duodenum.
Release of secretin, gastric inhibitory peptide and vasoactive intestinal peptide does not fully
explain the inhibition.
The greatest ability of the stomach to secrete acid is measured by collecting gastric secretion in
successive 15min periods after the subject has been given what is thought to be a sufficiently
strong stimulus. The sum of the acid output in the two highest consecutive 15mins period is the
peak acid output (PAO) and the maximum acid output (MAO) is the output found in the whole
hour after the stimulant is given. Both are expressed in mill equivalents of acid per hour.
For long time histamine, 0.04mg/kg injected subcutaneously has been used to stimulate acid
secretion. As a result of its side effects histamine has been replaced by Pentagastrin in a dose
6mg/kg given subcutaneously or intra muscularly. With this method it has been shown that on
the average, peak acid output increase with body weight and with lean body mass, that men
secrete more acid than women., that the secretion of acid falls off after the age of 50years, that
patients with duodenal ulcers secrete more acid than normal subjects and that patient with
gastric ulcer secrete far less acid than control subjects.
Gastric Analysis
This study is carried out in man by the use of tubes to obtain gastric contents. A great variety of
stomach tubes have been used in the past. Recently tubes of the small size e.g. no 12 French
gauge, disposable plastic tubes are also common.
The analysis is commonly done in the morning after an overnight fast. If the patients are on
drugs, all such drugs will be discontinued 12 hours prior to test.
The tube is usually passed through the nose so as to cause less discomfort over a period of time.
Most gastric tubes are marked so as to know the distanced travelled.
Methods
The histamine test is better than the test meal for the following reasons.
1. Histamine test is capable of evoking hydrochloric acid secretion where a test meal fails.
2. The secretory response is not affected by appetite or psychic factors.
3. Varying amount of saliva added to gastric secretion due to test meal is absent histamine
test.
4. With the test meal, the swallowed saliva and the test meal itself neutralizes the acid.
Assignment
Write a comprehensive essay on gastric secretagogues