PH and Concentration of Pancreatic Enzymes in Aspirates from the Human Duodenum during Digestion of a Standard Meal

Abstract

This study comprises 39 patients with duodenal ulcer, 113 patients with partial gastrectomy, 9 with total gastrectomy and 6 patients with gastroenterostomy. After ingestion of a standard meal the intestinal contents were collected during 4 subsequent periods of 20 minutes each. The volume, pH, and the concentrations of alpha-amylase, trypsin, chymotrypsin, and lipase in the collections were determined. The pH was not below normal in patients with duodenal ulcer. The results indicated an admixture of salivary to pancreatic amylase in the intestine of patients with gastrojejunostomy, especially by concomitant hypochlorhydria. In all groups of patients, secretions of trypsin and chymotrypsin were closely related. In patients with partial or total gastrectomy, the secretion of lipase was more markedly reduced than the secretion of the other enzymes. The mean concentration of lipase in the efferent loop in Billroth II patients was found to be closely related to the fat absorption. Depending on the enzyme concerned, 10-20 per cent of the patients with duodenal ulcer, and 21-50 per cent of the patients subjected to Billroth II gastrectomy had abnormally low concentrations of enzymes in all collections. In these groups of patients, the mean concentration of the four enzymes was significantly reduced in all collections. In patients exposed to Billroth I gastrectomy, gastroenterostomy, or total gastrectomy, mean concentrations of the enzymes were below normal levels in collection I only.