Pentagastrin test

Introduction
Pentagastrin is a synthetic peptide in which Nterminal end is blocked by butyl-oxycarbonyl-alanine.
Trp-Met-Asp-phe (CONH2).
The four C-terminal amino acids form the
active part of the molecule.
Pentagastrin is a potent stimulator , and
involves the maximal stimulation of stomach after
a period of assessment of the basal secretion
rate.

Indication

Useful in investigation of patients with active

duodenal ulcer , which may suggest appropriate
surgical measures.

Useful in suspected cases of Zollinger-Ellison

syndrome.

Procedure
(1)The patient must be in the fasting state and
free from sight or odour of food overnight.
(2)All medications that can influence gastric
secretion must be witheld for 24 hours.
(3)The patient must be isolated from
environmental situation evoking untoward
psychological response such as fear , anger or
depression.
(4)Pass a number 14 Ryles tube through the nose
until it is lying on the pyloric antrum.
The markings on the tube show how far the tube
has been pushed down.

(5)All the gastric juice is aspirated from the

stomach.
This specimen is the resting juice.
(6)In next 1 hour the juice is collected at 15
minutes interval and thee sample is called basal
juice.
(7)The patient is injected intramuscularly with
6g per kg body weight of pentagastrin.
This gives maximal secretion.
(8)The gastric juice is aspirated for four
consecutive 15 minute periods and the samples
are labelled 1 , 2 ,3 ,4.
(9)The laboratory should receive the following
samples:-

Gross examination of
gastric
juice
Volume
Normal fasting content is about 50-100ml ; and
the average daily volume is 2-4 litres.

Appearance
It is normally colourless-grey in appearance but
the fluid assumes various colours under
pathological conditions.
(1)Blood:-Blood is red or coffee brown if acid
haematin is formed.
(2)Bile:-Fresh bile is yellow while old bile is green.
(3)Food colours:-In stasis , food colours may

Odour
Normal odour of gastric fluid is sour or slightly
rancid.
It has faecal odour in intestinal obstruction and
ammoniacal in uraemia.

pH

The pH range is 0.9-1.5 due to hydrochloric acid

produced by the parietal cells.

Water
Water content of gastric fluid is about 89-99%.

Other constituents
The gastric juice also contains inorganic
substances such as sodium , potassium ,chloride ,
calcium , magnesium , phosphate and sulphate ;
and organic substances like pepsin , mucin , renin
(Only in the stomach of a child) , albumin , lipase
and globulin.
Abnormal gastric constituents include:-(a)Blood.
(B)Food remnants hours after eating.

Character of the fluid

When left to stand for 3 hours , three layers are

formed:-(a)Top-mucus.
(B)Middle-Opalescent fluid.
(C)Bottom-bread-like residue.

Laboratory procedure
(1)Measure and record the volume of each
sample.
(2)Inspect for the presence of blood , bile or
mucus.
Blood is usually brown due to the change of
haemoglobin to acid haematin.
Bile will colourthe gastric aspirate green.
(3)Determine the pH of the juice using indicator
papers or pH meter.
If pH is greater than 7.0 , titration need not be
done.
(4)Determine the titrable acidity of each

tration of acidity in gastric jui

Reagents
(1)Na OH , 0.02N:-Dilute 20.0ml stock solution of
0.1mol/l of Na OH to 100ml with distilled water.
This gives 0.02N Na OH. Standardise.
This is prepare fresh each day.
(2)Indicator:-Neutral red , 0.1% in 70% alcohol or
phenol red:0.1g phenol red , 5.7ml 0.5 N Na OH
diluted to 250ml with distilled water.

Method
(1)Spin the gastric juice.
(2)Transfer 1 ml of the clear gastric juice into a
small flask , add 2-3 drops of the indicator.
(3)Titrate each sample with the standardised 0.0N
Na OH until a faint pink endpoint is reached.
(4)Note the titre and record the result.

Calculations
1.0ml of 0.02 Na OH is equivalent to 20mmol/l.
Therefore , if t=titre of gastric juice , v=volume
of sample used for the test , and T=volume of
specimen collected.

Clinical significance
(1)Hypersecretion of gastric acidity
(hyperchlorhydria) is indicative of peptic and
duodenal ulcers in which acid secretion is high.
For duodenal ulcer, the value of basal acidity is
>5mmol/l while the maximal total acidity is2060mmol/l.
Hyperchlorhydria is also indicative of ZollingerEllison syndrome in which basal acidity secretions
is >10mmol/l.
(2)Hyposecretion of gastric acidity
(hypochlorhydria) or absence of gastric acidity
(achlorhydria) is associated with pernisious