Effect of fundic distension on gastric acid secretion in man.

Abstract

SUMMARY The effect of distension of the fundus and body of the stomach on gastric acid secretion was studied in 26 patients with duodenal ulcer and six healthy subjects. Graded distension produced by inflating a rubber balloon to volumes of 150, 300, and 600 ml resulted in significant sequential increments of acid output. The secretory response outlasted stimulation by at least one hour. In both groups of subjects, the highest acid output obtainable with fundic distension amounted to just above 50 % of the maximum secretory response evoked by intravenous infusion of pentagastrin. A significant correlation was found between the peak secretory rates observed during fundic distension and after pentagastrin stimulation. It is concluded that distension of the oxyntic gland area in man is a potent stimulus for gastric secretion of acid and that patients with duodenal ulcer are no more sensitive to this stimulus than healthy subjects.Food reaching the stomach stimulates the parietal cells to secrete hydrochloric acid by virtue of its physicochemical properties-that is, by activating enteroceptors which are susceptible to chemical and mechanical stimuli. In the dog, mechanical stimulation by gastric distension brings about acid secretion by means of two mechanisms: direct neural activation of the oxyntic glands and pH-dependent release of antral gastrin (Grossman, 1967). This basic concept of dual reflex action applies to both antral and fundic distension (Grossman, 1961(Grossman, , 1962Debas et al., 1974;. In man, the acid response to the ingestion of test meals has been extensively studied (Hunt and Macdonald, 1952;Rune, 1966;George, 1968;Cooke, 1970;Fordtran and Walsh, 1973;Malagelada et al., 1976). This integrated secretory response is influenced by factors including psychic stimulation, the volume and composition of the meal, the rate of gastric emptying and the effects of chyme on the intestine. Only sparse information is available on the acid secretory effect of the different components which constitute the gastric phase in man. Recent work has shown that antral distension stimulates acid secretion in patients with duodenal ulcer by way of a mechanism which is pH-independent and not mediated by gastrin (BergegArdh et al., , 1976b. In contrast, healthy subjects did not respond to antral distension.Received for publication 10 September 1976 In the present study, the acid secreting part of the stomach was distended with a balloon and the effect of graded fundic distension on acid secretion was examined in patients with duodenal ulcer and in healthy subjects. Methods SUBJECTS STUDIEDPatients with duodenal ulcer (DU) Twenty-six male sulbjects (mean age 44 years, range 20-63 years) with chronic duodenal ulceration awaiting elective surgery were studied. The diagnosis was established by endoscopy and/or barium meal examination and confirmed at operation. In no patient was there any evidence of gastric outlet obstruction.Healthy subjects Six healthy men (mean age 23 years, range 20-25 years) without any history of gas...

Effect of atropine and proximal gastric vagotomy on the acid response to fundic distension in man.

“…Details of the methods for determining acid output and of the fundic distension procedure used in this study have been given elsewhere (Grotzinger et al, 1976). Any anticholinergic medication was discontinued two days before the tests.…”

Defective Inhibition of Gastrin Release by Antral Distension in Duodenal Ulcer Patients

“…On the other hand, recent observations have suggested that whole stom ach distension released even more gastrin fol lowing atropine administration, implying that cholinergic pathways normally inhibit gastrin release [22], The response to whole stomach distension may, however, be difficult to inter pret since both the fundic and antral regions are distended simultaneously. It is quite ob vious that both inhibitory and stimulatory mechanisms are operating from the fundic as well as from the antral region when a local dis tension stimulus is applied [5, [23][24][25], Pure antral distension in healthy volunteers inhib its pcntagastrin-induced acid secretion [5], We found antral distension to exert an inhibi tory influence on the gastrin response to both a low and a high dose of GRP in healthy vol unteers. This inhibitory effect may be of cho linergic nature, since it was completely abol ished by benzilonium bromide pretreatment.…”

“…Two included 6 healthy volunteers, each one with 2 males and 4 females, with a mean age of 26 years (range [24][25][26][27][28]) and the other included I male and 5 females with a mean age of 25 years (range 23-29). In addition.…”

A Study of the Effect of Antral Distension on Gastric Acid Secretion in Man

“…The antral distension has been performed with a balloon, the filling of which never generated pressures exceeding 15-20 cm water (4). Exclusive antral distension has been used since fundic distension stimulates acid secretion in both healthy sub jects and duodenal ulcer patients (10). The maximal volume of the balloon for exclusive antral distension is 150 ml (4).…”