Pyloric Reflux: A Modification of the Two-Component Hypothesis of Gastric Secretion

Abstract

S U M M A R Y1. Gastric juice was obtained during continuous maximal stimulation with histamine diphosphate, 0.13 pmol h-' kg-l (0.04 mg h-' kg-l) intravenously, in thirtyfour control subjects, twenty-eight patients with duodenal ulcer, and eighteen with gastric ulcer. After correction for pyloric losses, the average rate of outputs of water, and of H', Na', K+ and C1-were determined.2. The results were analysed in terms of the two-component theory of gastric secretion. The acid components in control subjects and duodenal ulcer patients were similar in composition, but that in gastric ulcer patients was by comparison hypotonic and less acid and contained more sodium ions.3. Calculation of the volume and composition of the alkaline component gave reasonable results in the control and duodenal ulcer groups, but impossible results in the gastric ulcer group. The gastric juice of gastric ulcer patients could not be described in terms of classical two-component theory. 4.In all three groups, volume correlated quite well with Cl-output alone, less well with H' output, poorly with K' output, and not at all with Na' output. However, when volume was expressed as a function of the outputs of C1-and one other ion, K+ performed poorly, H' well, and Na' best of all.5. Some features suggest that reflux of alkaline liquid from the duodenum is a better explanation of these results than back-diffusion of H' in exchange for Na' between the lumen and wall of the stomach.6. If the refluxing liquid is assumed to be isotonic, its composition can be calculated. Hence, the volume of reflux in a sample of gastric juice can be deduced. Reflux appeared to be more important in the gastric ulcer patients than in the other two groups.

The quantification in human gastric juice of duodenogastric reflux by sodium output and by bile-labelling using indocyanine green

“…The correlation between the results obtained with ICG and the indirect calculation of reflux from the sodium output (Hobsley, 1974) supports the use of the latter technique. A previous paper (Faber et al, 1974) has considered the spontaneous occurrence of duodeno-gastric reflux during insulin-stimulated secretion.…”

“…It seems certain that quantitative knowledge of the contribution of duodeno-gastric reflux will allow a more accurate characterisation of true gastric secretion and hence a more detailed understanding of its control. Hobsley (1974) calculated the electrolyte concentrations in pure acid component as the slopes of the regressions of output of each electrolyte against volume-rate of secretion. He further calculated the electrolyte composition of duodenal reflux (during maximal histamine stimulation) by assuming that the reflux contained a sodium concentration of 146 m-mol/1 and was isotonic with pure acid component.…”

“…Indeed Du Plessis (1965)has emphasised the importance of duodeno-gastric reflux, not only as an explanation of the observed hypoacidity and hypotonicity of gastric aspirate in patients with gastric ulceration, but also in the aetiology of the condition. Alternative explanations involving back diffusion (Teorell, 1947) or increased alkaline Component (Hirschowitz, 1961) do not fit the data so well (Hobsley, 1974).…”

“…This formula is based on that of Hobsley (1974) and subsequently slightly modified (Faber et at., 1974), and depends upon the two assumptions about the composition of reflux that have been stated in the Introduction. The proportion of reflux was obtained by dividing VR by V~or.…”

The Effect of Somatostatin on Bombesin-Stimulated Serum Gastrin and Gastric Acid Secretion in Man

“…Gastric acid output was calculated by multiplying the volume of the gastric aspirate over 15 min with the concentration. When gastric acid secretion was corrected for pyloric loss by calculating the recovery of the marker polyethyleneglycol 4000 (11) and for duodenal reflux according to the method of Hobsley (12), results were identical to uncorrected values.…”