Gastric and Pancreatic Function and the Absorption of Iron,Vitamin B12, and Calcium after Proximal Gastric Resection for Cancer in the Upper Part of the Stomach

Twelve patients with proximal gastric resection for cancer of the proximal part of the stomach were included in a follow-up examination 2–8 years after the operation. Six were underweight, 1 had mild anaemia, and 1 had definite X-ray signs of osteoporosis. B₁₂ absorption was normal in 7; iron absorption was reduced, while calcium absorption was normal, in all. External pancreatic function was not definitely reduced. About half the patients had postcibal complaints in the form of the small stomach syndrome and regurgitation with pyrosis, which were not found after total gastrectomy.     

Parietal Cell Secretory Function in Early Childhood

The secretory patterns and hourly outputs of volume, acid, and intrinsic factor secretion after augmented histamine stimulation were studied in 18 children without gastrointestinal disorders, 9–30 months of age.

The stimulated outputs of acid and intrinsic factor were correlated to age, body-weight, and body surface area. The results indicate that the secretion of intrinsic factor in this age group is more mature than the secretion of acid.     

Reproducibility of Ambulatory Gastric pH Recordings in the Corpus and Antrum: Effect of Food,Time, and Electrode Position

The reproducibility of simultaneous, long-term, ambulatory gastric pH recordings in the antrum and corpus was investigated in nine healthy subjects who underwent three separate, 27-h gastric double pH-metries. Intraindividual reproducibility for the entire 27-h recording period was good in the corpus (Kendall's concordance coefficient, W' = 0.6393, p < 0.025) but not in the antrum (W' = 0.4806, NS). Analysis of predefined time periods showed that non-meal daytime pH was reproducible in the corpus (W = 0.6531, p < 0.025) but not in the antrum (W' = 0.3395, NS), whereas mealtime pH was reproducible in the antrum (W' = 0.7159, p < 0.005) but not in the corpus (W = 0.4954, NS); nocturnal pH was not reproducible in either the antrum or the corpus. These results reflect the functional separation of corpus and antrum and their differing responses to food. Thus, studies of gastric acidity over long periods should be conducted in the corpus, whereas studies of gastric acidity over shorter, meal-related periods should be conducted with a second electrode in the antrum.     

Inhibition by Pirenzepine of Nocturnal Gastric Acid Secretion in Duodenal Ulcer Patients

Ten patients with endoscopically proven duodenal ulcers participated in a double-blind, placebo-controlled, cross-over trial to investigate the effect of pirenzepine on nocturnal gastric acid secretion. Pirenzepine, 50 mg orally at bedtime, inhibited acid secretion all night long: the overall volume secreted and acid output (midnight to 7 a.m.) were significantly less than after placebo. The decrease in acid output per hour was significant at 1, 2, 3, 6, and 7 a.m. and the decrease in acid concentration of gastric juice at 2, 6, and 7 a.m. It was concluded that controlled clinical trials of maintenance therapy for prevention of relapse of healed duodenal ulcers should be carried out with the pirenzepine taken at bedtime.     

Protective Action of Saliva in Peptic Ulceration

The effect of saliva on gastric secretion was studied in 41 adult men by the method of serial test meals. The essence of the experiments was to exclude the saliva from the stomach in one set of observations and allow its admixture with food in the other.

The results showed that the gastric acidity was significantly reduced by the ingestion of saliva both in the case of fluid as well as solid meals. Differences in the mean acidities of the samples were larger in the case of masticatory meals (P<0.001) whereas in the case of non-masticatory sloppy meals these differences were small and not significant. The mucus in the aspirates from the stomach was mostly of salivary origin, and it seems likely that the buffering action of saliva was exerted not only through its bicarbonate content but also through its mucus content. Variations were observed in the titre of group-specific substances as well, but their significance was less clear. These results have implications with regard to the possible protective action of saliva in peptic ulceration.     

Measurement of Gastric Hydrochloric Acid after Maximal Histamine Stimulation with Special Reference to Achlorhydria

Titration to different pH end points was performed in all samples of gastric juice from 208 patients with gastro- instestinal diseases and healthy persons, examined with the augmented histamine test.

Titration to pH 3.3 and to pH 7.0 revealed differences in hydrogen ion concentration, which were significantly negatively correlated to the maximal acid output, calculated from the acidity at pH 3.3.

Differences between maximal acid outputs, calculated from the acidities at pH 3.3 and pH 7.0, varied only little in all examined groups with the exception of gastric juice contaminated by food.

Titration to pH 7.0 or higher overestimates gastric hydrochloric acid, especially in gastric juice from patients with gastritis and gastric juice contaminated by food.

The results of this study support previous investigations, which recommend titration of gastric juice to pH 3.5 with simultaneous measurement of pH. Achlorhydria corresponding to absence of parietal cells is hereby defined by a pH higher than 3.5 and a pH fall less than one pH unit from basal to maximally stimulated values.     

Time pattern of gastric acidity in Barrett's esophagus

Increased gastroesophageal acid reflux is frequently found in patients with Barrett's esophagus, and it has been hypothesized that gastric acid hypersecretion could be an important factor aggravating the exposure of esophageal mucosa to acid and then contributing to the development of this disorder. The aim of the present study was to assess whether the circadian pattern of gastric acidity differs between refluxer patients with and without Barrett's esophagus and normal subjects. Continuous 24-hr gastric pH monitoring was performed in 119 healthy volunteers, 20 patients with Barrett's esophagus, 37 patients with moderate and 10 patients with severe reflux esophagitis without Barrett's esophagus. In all these diseases the final diagnosis was ascertained by means of endoscopy plus biopsy. There was no difference in the 24-hr and daytime patterns of gastric pH between healthy subjects and patients with Barrett's esophagus, while nocturnal acidity was significantly lower (P<0.05) in the latter population. Gastric acidity, in contrast, was higher (P<0.05) in controls than in patients with both moderate and severe reflux esophagitis without Barrett's esophagus during the whole 24-hr period. There was no difference between refluxer patients with and without Barrett's esophagus in any of the three time intervals we analyzed. Because normal subjects had lower gastric pH than patients with Barrett's esophagus during the night and than patients with reflux esophagitis during the whole 24-hr period, gastric hyperacidity is not a relevant factor in the development of both metaplastic columnar epithelium and inflammatory changes in the distal esophagus, and other pathophysiological mechanisms are involved in these histological alterations.     

Analysis of Ambulatory Duodenogastroesophageal Reflux Monitoring

Some methodological in vitro observations concerning bile reflux monitoring (Bilitec) suggested that Bilitec monitoring is underestimating reflux in an acid environment. Moreover, other studies showed that the area above the cutoff level of bilirubin absorbance would provide an adequate quantitative marker for reflux of duodenal contents. Our aim was to study whether correction for intraesophageal acidity and the area above cutoff during Bilitec monitoring affects the results and the correlation with pH measurement and esophageal lesions. In 84 patients (46 men; mean age 46 ± 2.7 years) evaluated for suspected gastroesophageal reflux disease, we performed ambulatory 24-hr esophageal pH and Bilitec monitoring after an upper gastrointestinal endoscopy. We obtained total area, percent total time, and correction by computer software. The correction factor for bilirubin absorbance was based on literature data for acidified bile (0.06 for pH < 3.6; 0.21 for pH < 2.6). Endoscopy revealed esophagitis grade 1–2 (E1–2) and 3–4 (E3–4) in 23 and 16 patients, respectively. A progressive increase of mixed (acid + bile) reflux occurred with increasing severity of endoscopic lesions (E3–4 vs no esophagitis, P < 0.05). A pathologic Bilitec monitoring result was present in the same 35 patients before and after correction and the correlation between the pH measurement and percent time of bile reflux was not improved by correction for intraesophageal pH (r = 0.386 and r = 0.391; P < 0.05). The total area of bilirubin absorbance above 0.14 (abs × min) was 7.8 ± 2.2 in patients without esophagitis, and 11.7 ± 4.4 and 17.0 ± 4.2 in the E1–2 and E3–4 groups, respectively (E3–4 vs no esophagitis, P < 0.05). The correlation between the Bilitec monitoring and pH measurement regarding percent (r = 0.427, P < 0.01) or area of time below 4 (r = 0.280, P < 0.05) was not improved by considering the area of bilirubin absorbance above the cutoff level. Correction for intraesophageal pH has only a minor effect on the results of ambulatory Bilitec monitoring. Taking into account the surface rather than the percent of time above the cutoff level for bilirubin absorbance does not improve the correlation of Bilitec with acid reflux and with esophageal lesions.     

Granulocyte Kinetics in Burned Mice:Inhibition of Granulocyte Growth studied in Vivo and in Vitro

Granulocyte kinetics after standardized, sublethal, third-degree burn injury were studied in mice in vivo and in vitro using tritiated thymidine. Total haematopoietic activity was determined and autoradiographic analyses were made 2 hours to 30 days after the burn injury. During the first few hours postburn there was a 50% inhibition in the total incorporation of ³H-TdR in DNA and a 30% suppression in the labelling index for late proliferating granulocytes. The results suggest a selective destruction of bone marrow tissue, exhaustion of the marrow granulocyte reserve, inhibition of cell production and aimless distribution of cells in the tissues followed by rapid destruction, and subsequent release of cellular contents. Strong leukocytosis during the first days postburn reflects the leukocyte release. The burned organism is short of granulocytic phagocytes from the third day post-burn, and although the bone marrow quickly overcomes the initial suppression, these cells are available to the organism only after the first week postburn. The results obtained in vitro indicated that the inhibition of granulocyte production and the accelerated release are not entirely locally induced but may involve humoral regulatory mechanisms.     

Metal-Exchanged β Zeolites as Catalysts for the Conversion of Acetone to Hydrocarbons

Various metal-β zeolites have been synthesized under similar ion-exchange conditions. During the exchange process, the nature and acid strength of the used cations modified the composition and textural properties as well as the Brönsted and Lewis acidity of the final materials. Zeolites exchanged with divalent cations showed a clear decrease of their surface Brönsted acidity and an increase of their Lewis acidity. All materials were active as catalysts for the transformation of acetone into hydrocarbons. Although the protonic zeolite was the most active in the acetone conversion (96.8% conversion), the metal-exchanged zeolites showed varied selectivities towards different products of the reaction. In particular, we found the Cu-β to have a considerable selectivity towards the production of isobutene from acetone (over 31% yield compared to 7.5% of the protonic zeolite). We propose different reactions mechanisms in order to explain the final product distributions.