A Single Aspiration Caffeine Gastric Analysis in Duodenal Ulcer and Control Patients

Abstract

In most patients the diagnosis of duodenal ulcer may be definitely established or ruled out by an adequate history and careful radiographic studies. There is, however, a sizable group of patients in whom some or all of the findings are equivocal, and in whom additional diagnostic measures may be useful. Study of the basal or caffeine-induced gastric secretion may offer considerable aid, but these tests have not been used widely. We have attempted to simplify the caffeine test for possible use as a routine procedure. The traditional Ewald meal provides helpful information of several kinds but is of little value in diagnosis. When the convenient single aspiration technique is used, the frequency distribution curves for normal and duodenal ulcer patients are closely similar (1). Using the Rehfuss fractional modification there is less overlapping, but still not enough separation of ulcer from non-ulcer cases to be useful for this purpose (2). Similar overlapping exists for the alcohol (3) and histamine (4, 5) tests. These tests do not afford diagnostic aid in the individual case, except in the relatively few instances of extreme hypersecretion in the range beyond that of non-ulcer subjects, or in the event of achlorhydria after adequate histamine tests. In the latter circumstance benign peptic ulcer can be excluded. A test of basal secretion may give more aid. In the experience of Levin, Kirsner and Palmer (4), only seven per cent of 222 patients with duodenal ulcer had one or more IS-minute periods of anacidity during a one-hour test of unstimulated morning secretion. Furthermore, only one patient in this series had four such periods with absence of acid. Obviously, this test would be of great help in excluding the diagnosis of ulcer, but it is limited by the fact that 55 per cent of normal males and 40 per cent of normal females produced acid in all four periods. In our experience a further limitation is that small volumes of gastric juice are often produced, requiring considerable care and skill in aspiration for accurate results. The test most likely to aid in the diagnosis of individual cases appeared to us to be the caffeine test devised by Roth, Atkinson and Ivy (3), the value of