SUMMARY Median concentration of plasma secretin in the fasting state in 11 achlorhydria patients, 17 normal subjects, eight duodenal ulcer patients, and 11 Zollinger-Ellison patients was 0 3, 1.2, 2-5, and 5 9 pmol x 1-1, respectively. Aspiration of gastric acid in normal subjects and duodenal ulcer patients was followed by a significant lowering of the plasma secretin concentration. In normal subjects insulin-induced hypoglycaemia resulted in increased secretin levels when gastric acid was allowed to enter the duodenum, whereas no changes were observed when gastric acid was aspirated. Simultaneous measurements of intraduodenal pH and plasma secretin concentration in the fasting state and in response to a meal showed that rapid falls in intraduodenal pH were followed by short-lived increments in plasma secretin concentration. These changes in pH and in secretin levels were diminished after cimetidine. It is concluded that gastric acid in man does trigger release of secretin and that secretin is secreted intermittently both in the fasting state and in response to a meal when boluses of acid enter the duodenum.In recent years several radioimmunoassays for secretin have been presented. The assays all measure increased concentrations of secretin in human plasma after intraduodenal infusion of various, often unphysiologically large amounts of acid (Boden and Chey, 1973;Bloom, 1975;Byrnes and Marjason, 1976;O'Connor et al., 1976;Rhodes et al., 1976;Hanssen and Torjesen, 1977;Schaffalitzky de Muckadell and Fahrenkrug, 1977). Intraduodenal acidification is for the moment the only well-established stimulus to secretin release (Boden et al., 1975;. It has, however, been questioned whether the requirements for release of secretin are met in human physiology (Wormsley, 1973) and it has been difficult to demonstrate changes in secretin concentrations in plasma during physiological conditions in man (Rhodes et al., 1976; Received for publication 10 April 1978 release of the hormone is expected to be dependent on acid in the duodenum.The present study was therefore undertaken in order to examine the effect of endogenously released gastric acid on plasma secretin concentration in man.
MethodsSeventeen normal subjects, eight duodenal ulcer patients, 11 unoperated patients with the ZollingerEllison syndrome, and 11 patients with achlorhydria volunteered for the study after the purpose, nature, and possible risks had been carefully explained to them.In normal subjects (median age 30 years, range 24-63 years, six females) none had any history of gastrointestinal or endocrine disease. In duodenal ulcer patients (age 33 years, range 24-66 years, three females) the diagnosis was based on the demonstration of ulcer by endoscopy and radiological examination. In Zollinger-Ellison patients (age 46 years, range 32-72 years, four females) the diagnosis was established on the basis of classical history, hypersecretion of acid, and hypergastrinaemia of extragastric origin. Achlorhydria was demonstrated by the augmented histamine test, the ...