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SUMMARY Twenty four hour intragastric acidity was measured by continuous recording using intragastric combined glass electrodes in 46 duodenal ulcer patients within 48 hours of endoscopic confirmation of active ulceration. Acidity during predefined time periods was compared with that measured in 40 healthy controls without gastrointestinal disease: it was significantly higher in duodenal ulcer patients at all times, but 25% of ulcer patients had median 24 hour acidity within the interquartile range of the normal group. During the evening (18 00 to 22 00 h) ulcer patients had considerable acidity with a median of 39.8 (63 1-31.6) mmolIl (interquartile range) compared with 5.6 (22-3-0.4) mmolIl of controls. It is suggested that antisecretory treatment be directed to decrease this period of unbuffered acidity, as well as during the night, which is presently considered of prime importance.The role of gastric acid secretion in the pathogenesis of duodenal ulcer disease is poorly defined. It is agreed, however that as a group duodenal ulcer patients secrete greater quantities of acid than normal subjects. Most formal studies clearly show a large degree of overlap, with approximately 30% of ulcer patients secreting apparently normal volumes of acid.' Attempts to further separate ulcer patients from the normal group have intimated that differences are most prominent during the night and in response to food.24 Some workers dispute these differences and claim that methodological problems could explain observations.' Most recently a technique which measures total 24-hour acid secretion has confirmed that duodenal ulcer patients secrete more acid than normal subjects under basal and stimulated conditions.' A circadian pattern of gastric secretion under basal conditions has also been reported for normal subjects9 and duodenal ulcer."'In these earlier studies the methods used may have obscured true differences which might occur in real life, and ambulant studies have not previously been

SUMMARY The value of multiple biopsies and brush cytology at oesophago-gastroscopy was assessed in relation to macroscopy and localization on 100 verified tumours in a prospective study. The cumulative accuracy achieved was 96 %. This was significantly better (P < 0.01) than that of biopsy (83 %) and of cytology (85 %). While the reliability of both procedures was not significantly different in malignancies of the oesophagus, the gastric body, and the antrum, cytology was significantly more accurate in cancers of the cardia (90 % and 55 % respectively, P < 0 05). Cytology was also more reliable in stenosing tumours (92 %/72%, P <0 05). In polypoid malignancies a positive but not significant trend was found in favour of multiple biopsies (94 %/64 %). One of the two early cancers was only diagnosed by cytology. The results confirm the high diagnostic accuracy of multiple endoscopic biopsies combined with brush cytology and demonstrate the value of cytology in stenosing tumours, especially in those of the cardia.The reported rate of accuracy of multiple endoscopic biopsies and of brush cytology is at great variance. False negative results were observed between 7% and 68% for biopsy (Dollinger, 1972;Hampel et al., 1974) and 4-2 %-56 % for brush cytology (Kobayashi et al., 1970;Dollinger, 1972). In the light of the difficulties in deciding whether an endoscopically visualized lesion is benign or malignant and the high value of a correct preoperative diagnosis, it was considered to be important to assess the reliability of both procedures in a prospective study. Also little is known of the value of both procedures in relation to the macroscopic aspect and the localization of an individual lesion and this question was therefore included in the protocol. MethodsTwo hundred and fifty-one patients with endoscopically suspect oesophageal (58) and gastric (193) lesions were investigated. The age of the 167 male and 84 female patients varied between 22 and 88 years (mean 57 8 years). Thirty-one had two ex-

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