A Technique for Screening of Achlorhydria and Hypochlorhydria during Upper Gastrointestinal Endoscopy

Measuring of the intragastric pH during upper gastrointestinal endoscopy examination was performed perendoscopically with a monocrystalline antimony electrode, which was passed through the biopsy channel of the endoscope. The procedure was easily performed, resulting in only a few minutes' delay. If the pH found was 3.5 or above, the patients were later sent for a subcutaneous pentagastrin aspiration test. There was a close correlation between the lowest intragastric pH measured via the endoscope and the lowest pH measured in the gastric juice aspirated under basal conditions (r = 0.673, p < 0.0001). An endoscopically assessed pH of 4.0 was the lowest level above which patients with achlorhydria or hypochlorhydria were found, according to the subsequent pentagastrin test. Fifty-five per cent of the patients with a perendoscopically assessed pH of 4.0 or above were achlorhydric.     

Application of Whole Body Counting to the Measurement of Vitamin B12 Absorption with Reference to Achlorhydria

Three hundred vitamin B₁₂ (B₁₂) absorption tests were carried out by whole body counting: sequential scanning may detect errors due to un-absorbed and unexcreted radioactivity. There was a poor correlation between two successive absorption tests in the same patient in the fasting state. The correlation improved when B₁₂-free meals were used, particularly in controls and achlorhydric patients without pernicious anaemia (PA). Single tests in the fasting state could not always distinguish between patients with and with-without PA. No constant relationship between intrinsic factor (IF) production following histamine or pentagastrin stimulation and B₁₂ absorption could be found in achlorhydric patients without small intestinal disease.     

Antral Gastrin Cells and Serum Gastrin in Achlorhydria

Forty-five patients with achlorhydria due to severe atrophic corpus gastritis or gastric atrophy were studied by determination of serum gastrin, histological examination of multiple biopsy specimens from the antrum, and quantitation of gastrin cells revealed by an indirect immunofluorescence technique. In a reference group of 12 persons with normal gastric secretion and without atrophic antral gastritis, the mean number of gastrin cells per field of vision was 52±6.5 (S.E.M.). In a group of achlorhydric patients having normal antral mucosa (n = 24), the serum gastrin level was 324±56 pmol/1 and the number of gastrin cells was 79.6±7.5 cells/field of vision. The corresponding values for a group of achlorhydric patients with chronic superficial antral gastritis (n = 11) were 361±186 pmol/1 and 88.0±14.4 cells/field of vision. In a group of achlorhydric patients with atrophic antral gastritis (n = 10) serum gastrin was 15.0±3.3 pmol/1, and the number of gastrin cells was 6.2±3.3 cells/field of vision. Compared to the subjects in the reference group, the number of gastrin cells was significantly higher in the groups of achlorhydric patients with normal or superficially inflamed antral mucosa and significantly lower in achlorhydric patients with atrophic antral gastritis. It is concluded that serum gastrin in general is a good indicator for the presence or absence of antral atrophic gastritis in achlorhydria.