A Study of Gastric Secretions in Chronic Obstructive Pulmonary Emphysema

Abstract

In a previous communication,’ we demonstrated that the incidence of chronic peptic ulceration in patients with chronic obstructive pulmonary emphysema is greater than would be expected by chance alone. Since a relationship between gastric acidity and arterial carbon dioxide tension might be postulated, a study of gastric secretions in this disease entity was done. Materials and Method Thirty unselected subjects with chronic obstructive pulmonary emphysema were studied. The diagnosis in each instance was substantiated by fluoroscopic observation and evaluation of pulmonary function. Each patient was studied in the fasting state. Intubation was carried out under fluoroscopic control and an indwelling arterial needle was inserted. Continuous gastric suction was applied until successive pH determinations agreed by 0.5 pH units. This usually consumed 50 to 70 minutes. pH was determined with a Cambridge Model R pH meter. Free acidity was determined by titration.’ Coincident with the final “basal” gastric juice collection, an arterial blood specimen was collected. Arterial oxygen saturation, carbon dioxide content and tension, and pH were determined by standard techniques.” Twenty-one of these subjects were then given carbon dioxide inhalations for 30 minutes each. Seven of these received 95 per cent oxygen and 5 per cent carbon dioxide and 14 inhaled 5 per cent carbon dioxide in air. Samplings of gastric juice and arterial blood were carried out during this period and for an ensuing 30 minutes. Control subjects consisted of 10 patients, over 40 years of age, who had no pulmonary or gastrointestinal disease. They were intubated and