GASTRIC AND

DUODENAL FLUID
ANALYSIS
Crizelda L. Salita, MS, RMT

AT THE END OF THIS UNIT, THE

LEARNER SHOULD BE ABLE TO:

GASTRIC PHYSIOLOGY

Three physiologic functions of the stomach

1.
2.
3.

Acts as an expandable reservoir for ingested

food
Initiation of protein digestion by pepsin
Gastric mucosa secretes intrinsic factor for
binding and absorption of vitamin B12 in the
ileum

GASTRIC PHYSIOLOGY

Mechanical functions are evaluated by:

Radiologic
Endoscopic
Pressure

measurements

GASTRIC PHYSIOLOGY

Three general phases of gastric secretion

1.

Cephalic (neurogenic) phase

1.

2.

3.

4.

2.
3.

Gastrin secreted by G cells in the pyloric gland &

stomach + delta cells of pancreas
Gastrin stimulates HCl by parietal cells & Pepsin
by the chief cells
Vagal excitation lowers the threshold of parietal
cells to gastrin stimulation
Gastric peristalsis and emptying is promoted

Gastric phase - gastric distention &

continued secretion of digestive juices
Intestinal phase- GIP inhibits gastric
secretion, lowering of pH levels

GASTRIC PHYSIOLOGY

Three general phases of gastric

secretion
2.
3.

Gastric phase - gastric distention &

continued secretion of digestive juices
Intestinal phase- GIP inhibits gastric
secretion, lowering of pH levels

CHEMICAL COMPOSITION OF GF
1.
2.
3.
4.
5.

HCl
Pepsin
Mucus
Miscellaneous substances: proteins,
enzymes & intrinsic factor
Rennin (in infants)
Gastrin

influences secretion of gastric acid;

influenced by parasympathetic stimulation of
vagus nerve and food

WHY ANALYZE GF?

Gastric acidity

1.

1.
2.
3.

Peptic ulcer
Zollinger-Ellison syndrome

2.
3.
1.

4.
5.

Anacidity (=/> 6.0 even w/ stimulation)

Hypochlorhydria (=/<3.5, 1.0 upon stim)
Achlorhydria (=/< 3.5 even w/ stimulation)

Triad of recurrent peptic ulcer, non B-islet cell

tumor of the pancreas and gastric acid
hypersecretion

Completeness of surgical vagotomy

Pernicious anemia

SPECIMEN COLLECTION OF GF

In the morning after an overnight (12 hour)

fast
Normally,

5 ml of clear or opalescent fluid free

of food particles, blood or bile (*M. tb)

Collect by oral or nasal intubation by

qualified health care provider.
Tube position in the stomach should be
verified (usu. By a fluoroscope)

SPECIMEN COLLECTION OF GF

Patient should not swallow excessive

amounts of saliva (saliva neutralizes gastric
juice)
Medications that would interfere with gastric
acid secretion should be discontinued 24 to
48 hours prior to the test.
Aspirations of gastric juice must be collected
in 15 minute interval time-labeled
containers.

SPECIMEN COLLECTION OF GF
TUBES
Ewald or Boas tube
Rehfuss tube
Levine tube
TEST MEALS
1. Ewald Test Breakfast
: 40gm bread, 400ml water
: well masticated
2. Dock Test Breakfast
: same as Ewald but uses shredded wheat biscuits
3. Boas Test Breakfast
: 1tbsp rolled oats, 1 qt water

4. Riegel Test Meal

: 400ml broiled beef steak, 150g mashed potato
5. Fischer Test Meal
: similar to Riegel but adds Ewald breakfast,
lb lean Hamburg steak
: higher acidity values
6. Alcohol Test of Gastric Function
: substitute for test meals
: 50ml of 7% alcoholic solution into the gastric
tube
7. Insulin Hypoglycemic test by Hollander
: hypoglycemia is a potent stimulus to gastric
acid secretion

ROUTINE ANALYSIS OF GF
Appearance
Clear to opalescent, pale gray, sl. viscous
Volume
50-75 mL (relative)
Odor
Faintly pungent
Color and presence of other substances (e.g. Mucus)
Microscopic exam
Gastric acidity

MEASURING GASTRIC ACIDITY

Basal acid output (BAO)

Direct

measurement of pH and hydrogen ion

concentration (previously titration w/ 0.1N NaCl)
Collect GF for 1 hour in unstimulated fasting state
NV: 4 to 5 mEq/hour (men>women due to body weight)

Maximal acid output (MAO) & Peak AO

Stimulate

with histamine, betazole, pentagastrin

(previously TEST MEALS)
Collect GF for 1 hour (15 min interval)
Total MAO = NV 16 to 26 mEq/hour
Sum of 2 highest consecutive quarterly readings PAO
BAO/MAO ratio = NV 0.3 to 0.6

INTERPRETATION OF RESULTS

Low acid output

ANACIDITY

- If the pH never falls below 6 even

after stimulation
ACHLORHYDRIA older term, refers to titration
values of pH 3.5
Seen in defective gastric mucosa (e.g pernicious
anemia, gastric carcinoma, megaloblastic anemia,
hypoplastic or hypochromic anemia, immunerelated disorders of thyroid/stomach/con. Tx)

Increased acid output

BAO

of 10 mEq/hr or more with little change upon

stimulation

MEASURING SERUM GASTRIN

Generalities:
1. Acid inhibits gastrin production that is why
gastrin is high in achlorhydria and low
increased acidity
2. Patients with the Zollinger-Ellison syndrome
have a tumor in the pancreas that increases
gastrin production so that serum levels are
high even in the presence of increased
gastric acidity

INTERPRETATION OF RESULTS

>1000 pg/mL
Z-E

syndrome

300-800 pg/mL
History

of vagotomy
Atrial G-cell hyperfunction (pseudo Z-E syndrome)
Gastric outlet obstruction
Gastroparesis
Use of acid-lowering medications (protein pump
inhibitors H2 blockers)
Atrophic gastritis
H. pylori infection
Pernicious anemia
Renal failure

DUODENAL FLUID

More difficult to obtain than GF

Normal volume 1200 to 1500 ml per day
Enzyme rich, clear with a pH of 8.0 to 8.5
Contains up to 145 mEq/liter of bicarbonate iron
Secretin testing
Tests

ability of pancreas to respond to stimulus

Low volume but normal bicarbonate and normal
amylase is indicative of pancreatic tumor

ENDOSCOPIC RETROGRADE
CHOLANGIOPANCREATOGRAPHY (ERCP)