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Clinical Pathology

Indications for Gastric Analysis

By Dayyal Dg.Twitter Profile | Updated: Sunday, 11 February 2024 14:50 UTC
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Gastric analysis involves the assessment of the quantity of acid produced by the stomach through the analysis of aspirated gastric juice samples. The estimation of gastric acid output encompasses both the baseline (basal) and the maximum (peak) levels achieved after the stimulation of parietal cells. Originally introduced primarily for evaluating peptic ulcer disease and determining the necessity for surgical intervention, the test’s significance has diminished over time. This decline is attributed to the decreased prevalence of peptic ulcer disease and the widespread availability of safe and efficacious medical treatments, thereby diminishing the prominence of surgical interventions.

Gastric analysis is a diagnostic procedure assessing the composition and activity of gastric juices, is employed in various clinical scenarios. Indications for gastric analysis include:

  1. To determine the cause of recurrent peptic ulcer disease:
    • To detect Zollinger-Ellison (ZE) syndrome: Zollinger-Ellison (ZE) syndrome stands as a rare pathology characterized by the development of multiple mucosal ulcers in the stomach, duodenum, and upper jejunum, attributed to a pronounced hypersecretion of stomach acid. This excessive acid secretion finds its roots in a gastrin-producing tumor originating in the pancreas. The diagnostic journey for ZE syndrome often involves gastric analysis, aiming to identify significantly heightened basal and pentagastrin-stimulated gastric acid outputs. Additionally, a more nuanced and specific diagnostic approach leverages the measurement of serum gastrin levels, both in the fasting state and under secretin stimulation. This multifaceted diagnostic strategy not only aids in confirming ZE syndrome but also plays a crucial role in assessing the responsiveness to acid-suppressant therapies.
    • To decide about completeness of vagotomy following surgery for peptic ulcer disease: The Hollander’s Test, also known as the Hollander-Wolff test, is a medical procedure used to evaluate gastric acid secretion. This test involves the administration of a histamine analog, typically histalog, to stimulate the release of gastric acid. The patient undergoes gastric analysis, and the acid output is measured in response to histalog stimulation. The Hollander’s Test is particularly valuable in assessing the function of parietal cells in the stomach, which are responsible for acid production. This procedure aids in diagnosing conditions related to gastric acid secretion, such as peptic ulcer disease or Zollinger-Ellison syndrome. During the test, gastric juice is aspirated, and the acid output is analyzed before and after the administration of histalog. It is used for the management and treatment of various gastrointestinal disorders. See Hollander’s test.
  2. To determine the cause of raised fasting serum gastrin level: Elevated levels of gastrin, known as hypergastrinemia, may manifest in various clinical conditions such as achlorhydria, Zollinger-Ellison syndrome, and antral G cell hyperplasia.
  3. To support the diagnosis of pernicious anemia (PA): Pernicious anemia stems from the impaired absorption of vitamin B12, resulting from the breakdown in intrinsic factor synthesis due to gastric mucosal atrophy. This condition is further marked by the absence of hydrochloric acid in the gastric juice, a state referred to as achlorhydria. In cases where facilities for vitamin assays and Schilling’s test are unavailable, gastric analysis becomes a valuable tool for demonstrating achlorhydria. It is crucial to note, however, that achlorhydria alone is insufficient for the definitive diagnosis of pernicious anemia.
  4. To distinguish between benign and malignant ulcer: Excessive acid secretion characterizes duodenal peptic ulcers, whereas gastric carcinoma is associated with a deficiency in acid production known as achlorhydria. However, anacidity is observed only in a limited number of cases involving advanced gastric cancer. Additionally, it’s worth noting that increased acid output is not universally present in all individuals with duodenal ulcers.
  5. To measure the amount of acid secreted in a patient with symptoms of peptic ulcer dyspepsia but normal X-ray findings: Excess acid secretion in such cases is indicative of duodenal ulcer. However, hypersecretion of acid does not always occur in duodenal ulcer.
  6. To decide the type of surgery to be performed in a patient with peptic ulcer: Elevated basal and peak acid outputs signify an augmentation in parietal cell mass, suggesting the necessity for gastrectomy. Conversely, an elevated basal acid output coupled with a normal peak output serves as an indicator for vagotomy.

References

  • Burtis CA, Ashwood ER (Eds). Tietz Fundamentals of Clinical Chemistry, 4th ed. Philadelphia: WB Saunders Co, 1996.
  • Drossman DA, Shaheen NJ, Grimm IS (Eds). Handbook of Gastroenterologic Procedures (4th Ed). Philadelphia: Lippincott Williams and Wilkins, 2005.
  • Rosenfeld L. Gastric tubes, meals, acid, and analysisrise and decline. Clin Chem 1997;43:837-42.
  • Wallach J. Interpretation of Diagnostic tests (7th Ed). Philadelphia. Lippincott: Williams and Wilkins, 2000.
  • Wolfe MM, Soll AH. The physiology of gastric acid secretion. N Engl J Med 1988;319:1707-14.
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