Augmented Histamine Test Research Articles

Changes in acid secretion over the years. A 30-year longitudinal study.

We studied the effect of aging on gastric acid secretion in 11 physicians who had augmented histamine tests while at medical school in 1962. One of them had a duodenal ulcer at the time. The augmented histamine test was repeated in 1991 and, in addition, upper gastrointestinal endoscopy was done to exclude peptic ulcer and to obtain biopsies for histologic analysis and assessment of Helicobacter pylori status. The mean basal acid output decreased from 7.3 to 1.9 mEq/hr during the 30-year period of follow-up (p < 0.001), and the mean maximum acid output decreased from 29.9 to 20.3 mEq/hr (p < 0.01). The maximum acid output data showed a profound decrease in 4 of the 11 participants, a lesser decrease in 4, and a minimal increase in the remaining 3. Histologic analysis suggested a greater likelihood of atrophic gastritis, H. pylori infection, or both in participants showing a pronounced decrease in acid secretion with aging.

Gastric cancer risk in achlorhydric patients. A long-term follow-up study.

Achlorhydria, determined by the augmented histamine test, is the functional expression of the most severe atrophic gastritis and is followed by a 4- to 6-fold increased risk of gastric cancer, as we found 5 cancers in 114 patients after a mean observation period of 8.4 years. The cancers developed from 1 to 17 years after achlorhydria diagnosis--three cases after more than 9 years. The study showed no difference in gastric cancer risk between patients with and without pernicious anaemia. Spontaneous achlorhydria is the late result of atrophic gastritis, which should be regarded the premalignant condition. The development of gastric cancer from pharmacologically reduced acid secretion must be regarded as highly hypothetical, since this is not followed by atrophic gastritis.

Can Simple Augmented Histamine Test Be Useful for Screening Dyspeptic Patients for Duodenal Ulcer Diagnosis?

International Journal of Clinical PracticeVolume 39, Issue 3 p. 93-93 Clinical Study Can Simple Augmented Histamine Test Be Useful for Screening Dyspeptic Patients for Duodenal Ulcer Diagnosis? P. Kar DM, P. Kar DM Department of Gastroenterology, Surgery and Radiology, All India Institute of Medical Sciences, New Delhi, 110029 IndiaSearch for more papers by this authorB. N. Tandon MS, FAMS, B. N. Tandon MS, FAMS Department of Gastroenterology, Surgery and Radiology, All India Institute of Medical Sciences, New Delhi, 110029 IndiaSearch for more papers by this authorD. K. Bhargava MD, PhD, D. K. Bhargava MD, PhD Department of Gastroenterology, Surgery and Radiology, All India Institute of Medical Sciences, New Delhi, 110029 IndiaSearch for more papers by this authorP. Dubey PhD, P. Dubey PhD Department of Gastroenterology, Surgery and Radiology, All India Institute of Medical Sciences, New Delhi, 110029 IndiaSearch for more papers by this authorM. Berry MD, M. Berry MD Department of Gastroenterology, Surgery and Radiology, All India Institute of Medical Sciences, New Delhi, 110029 IndiaSearch for more papers by this authorS. Nundy FRCS, MCH, S. Nundy FRCS, MCH Department of Gastroenterology, Surgery and Radiology, All India Institute of Medical Sciences, New Delhi, 110029 IndiaSearch for more papers by this author P. Kar DM, P. Kar DM Department of Gastroenterology, Surgery and Radiology, All India Institute of Medical Sciences, New Delhi, 110029 IndiaSearch for more papers by this authorB. N. Tandon MS, FAMS, B. N. Tandon MS, FAMS Department of Gastroenterology, Surgery and Radiology, All India Institute of Medical Sciences, New Delhi, 110029 IndiaSearch for more papers by this authorD. K. Bhargava MD, PhD, D. K. Bhargava MD, PhD Department of Gastroenterology, Surgery and Radiology, All India Institute of Medical Sciences, New Delhi, 110029 IndiaSearch for more papers by this authorP. Dubey PhD, P. Dubey PhD Department of Gastroenterology, Surgery and Radiology, All India Institute of Medical Sciences, New Delhi, 110029 IndiaSearch for more papers by this authorM. Berry MD, M. Berry MD Department of Gastroenterology, Surgery and Radiology, All India Institute of Medical Sciences, New Delhi, 110029 IndiaSearch for more papers by this authorS. Nundy FRCS, MCH, S. Nundy FRCS, MCH Department of Gastroenterology, Surgery and Radiology, All India Institute of Medical Sciences, New Delhi, 110029 IndiaSearch for more papers by this author First published: 01 March 1985 https://doi.org/10.1111/j.1742-1241.1985.tb07787.xRead the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL No abstract is available for this article. Volume39, Issue3March 1985Pages 93-93 RelatedInformation

FAILURE OF PROXIMAL GASTRIC VAGOTOMY FOR DUODENAL ULCER RESISTANT TO CIMETIDINE

45 patients with uncomplicated duodenal ulcer who did not respond to cimetidine underwent elective proximal gastric vagotomy (PGV). 39 of these, who had received cimetidine for an average of 5·2 months before surgery, were followed up for 20-67 months postoperatively. 18 (46%) of them were classified as grade IV (ie, failures) according to a modified Visick scale—17 (44%) had a recurrent peptic ulcer. Augmented histamine tests done in 17 patients showed an expected reduction of peak acid output, so maintenance of stomach acidity was unlikely to be a cause of failure of the operation. The presence of mental and social problems preoperatively was associated with a postoperative Visick grade IV. Despite repeated medical therapy, and reoperation in 6 patients, 10 (26%) patients still had severe pain and/or dumping at follow up. Proximal gastric vagotomy cannot be advocated in patients with uncomplicated duodenal ulcer resistant to cimetidine, and an alternative treatment is needed for these patients.

Recurrent pneumococcal sepsis and defective opsonization after pneumococcal capsular polysaccharide vaccine in a child with nephrotic syndrome

1. Welsh JK, and May JT: Antinfective properties of breast milk, J PEDIATR 94:1, 1979. 2. Robinson JE, Harvey BAM, and Soothill JF: Phagocytosis and killing of bacteria and yeast by human milk cells after opsonization in aqueous phase milk, Br Med J 1:1443, 1978. 3. Mowat AG, and Baum J: Chemotaxis of polymorphonuclear leukocytes from patients with diabetes mellitus, N Eng J Med 284:621, 1971. 4. Khan AJ, Evans HE, Glass L, et al: Abnormal neutrophil chemotaxis and random migration induced by aminoglycoside antibiotics, J Lab Clin Med 93:295, 1979. 5. Hill HR, Warwick W J, Dettloff J, and Quie P J: Neutrophil granulocyte function in patients with pulmonary infection, J PEDIAXR 84:55, 1974. 6. Pitt J, Barlow B, and Heird WC: Protection against necrotizing enterocolitis by maternal milk. I. Role of milk leukocytes, Pediatr Res 11:907, 1977. 7. Khan AJ, Mehta S, and Walia BNS: Augmented histamine test in newborn, Pediatr Clin India 4:361, 1969. 8. Paxsons CL Jr, and Cross CC: Survival of human leukocytes, J PEDIATR 94:61, 1979. 9. Kmetz M, Dunne HW, and Schultz RD: Leukocytes as carriers in the transmission of bovine leukemia: invasion of digestive tract of the newborn by ingested cultured leukocytes, Am J Vet Res 31:637, 1970. 10. Miller ME, and Ganges RG: Serum complement like opsonic activities in human, animal, vegetable and proprietary milks, Science 196:1115, 1977. 11. Keller HU, Heiss MW, and Cottier H: Physiology of chemotaxis and random mobility, in Miescher PA, and Jaffe ER, editors: Seminars in hematology, vol 12, New York, 1975, Grune & Stratton, Inc., pp 47-57.

Correlation of salivary and gastric acid secretions in duodenal ulcer patients in tropics.

Salivary flow rates on mechanical stimulation by forced spitting method and by chemical stimulation with 10% citric acid and gastric acidity using an augmented histamine test were determined in 20 adult patients suffering from duodenal ulcer and in 20 adult control subjects matched with respect to age, sex, and body weight. Salivary flow rates were found to be much higher in response to chemical than to mechanical stimulus in both the groups. Duodenal ulcer patients exhibited an unexplained exaggerated response to chemical stimulation. Salivary pH, amylase, sodium, and potassium levels showed no significant differences between the two groups. The flow rates by either method generally showed a positive correlation with body weight in both the groups. Histamine stimulated gastric acid secretion was higher in duodenal ulcer patients than in controls. Acid secretion did not appear to be related to weight and also showed no consistent correlation with the salivary flow rates. It was concluded that (1) the salivary flow was dependent on body weight in duodenal ulcer patients as well as in controls, and (2) although salivary gland hyperplasia could be postulated in duodenal ulcer patients on the basis of increased salivary flow, the latter was poorly related to maximal acid secretion and therefore, if a combination of parietal cell and salivary gland hyperplasia did exist, it should be considered as incidental.

Maximum acid output in duodenal ulcer patients with different length of history and controls without dyspepsia.

Recent studies suggest a normal maximum acid secretion in duodenal ulcer patients with a history of less than three years, but an increase of secretion in those with longer history. The validity of this hypothesis was investigated in groups of patients with operatively verified duodenal ulcer and history for less than 3, 3--6, and 7--10 years. Each group, including 21 men and nine women, was compared to two male and one female group of age-matched controls without dyspepsia. In smaller groups of 16 men it was possible to compare age-matched groups from a population of 376 men with histories for up to 22 years. Finally, 11 men with an ulcer history of less than one year were compared to 11 controls. All subjects had measurements of MAO by the augmented histamine test. MAO was significantly higher in patients with a history less than one year and less than three years, respectively, compared to controls. After correction of MAO for weight or lean body mass the difference remained significant in men, but not in the smaller groups of women. MAO in men with a history of from less than three up to 22 years did not show any maximum. Thus, the study did not support the assumption that gastric hypersecretion is a result of duodenal ulceration.

The Augmented Histamine Test is Obsolete

The Augmented Histamine Test is Obsolete

Gastric function in primary hyperparathyroidism in man.

1. GASTRIC function was studied pre-operatively in 55 patients with primary hyperparathyroidism. In all patients the diagnosis of hyperparathyroidism was proved by the removal of an enlarged parathyroid gland or glands, following which the serum calcium fell to normal or below. 2. Twenty patients (38 per cent) gave a history of dyspepsia. All patients were given a barium meal and 12 (22 per cent) were found to have a duodenal ulcer. Male patients had dyspepsia and/or an ulcer more frequently than female patients. 3. Kay's augmented histamine test was carried out in all patients. Six patients (11 per cent) had achlorhydria, six had hyperchlorhydria (11 per cent), the remaining patients secreting normal amounts of acid. The acid secretion did not differ significantly from that of a group of euparathyroid patients studied under similar circumstances who did not have duodenal ulcer on barium meal. 4. Antigastric-parietal-cell antibodies and antithyroid antibodies were absent in all 20 patients, including five with achlorhydria, tested. 5. Serum gastrin was slightly elevated in three out of 10 patients preoperatively, and there was no consistent change following parathyroidectomy. 6. Although there is a high incidence of dyspepsia and of duodenal ulcer in patients with primary hyperparathyroidism they do not tend to have increased acid secretion.

Gastric acid secretion and risk of recurrence of duodenal ulcer within six to eight years after truncal vagotomy and drainage.

The value of insulin and augmented histamine tests in predicting recurrence of duodenal ulcer within six to eight years after truncal vagotomy and drainage was assessed in a series of 500 consecutively and electively operated patients. Criteria of recurrence were established by a discriminative analysis of gastric acid secretion parameters. Recurrence was predicted with a probability of about 75% in patients with dyspepsia, the proportion between recurrences and dyspeptic nonrecurrences being 1:1. The discriminatory ability of the insulin test was no better than that of the postoperative histamine test. Men with a preoperative PAO > 46.1 m-equiv/h had a risk of recurrence of 21%, women with a PAO > 41.5 m-equiv/h, 28%. Below these levels the risk was 5 and 1% respectively, demonstrating that recurrence after vagotomy is related to the number of parietal cells before vagotomy. A rationale is provided for antrectomy and vagotomy in duodenal ulcer patients with a high number of parietal cells.

The Discriminatory Ability of Gastric Acid Secretion Tests in the Diagnosis of Recurrence after Truncal Vagotomy and Drainage for Duodenal Ulcer

Kronborg, O. The discriminatory ability of gastric acid secretion tests in the diagnosis of recurrence after truncal vagotomy and drainage for duodenal ulcer. Scand. J. Gastroent. 1973, 8, 483-489.The value of insulin and augmented histamine tests in predicting recurrence after vagotomy and drainage for duodenal ulcer was assessed in a series of 500 consecutively operated patients. Different criteria of recurrence were established by a discriminative analysis of gastric acid secretion parameters. Recurrence was predicted with a probability of about 50 per cent in patients with dyspepsia, the proportion between recurrences and dyspeptic non-recurrences being 1 : 3. The discriminatory ability of the insulin test was not better than that of the pre- and post-operative histamine test; also the time of performing the post-operative insulin test was of minor importance for the prediction of recurrence.

The relation between gastric acid secretion and body habitus, blood groups, smoking, and the subsequent development of dyspepsia and duodenal ulcer.

One hundred and seventy-six students free of gastrointestinal disease were studied to establish normal acid secretion values for healthy male and female students by the augmented histamine test and to re-examine the relationship between gastric acid secretion and ABO blood groups, body weight, fat-free body mass, height, degree of ectomorphy and mesomorphy, the number of cigarettes smoked per day, and serum cholesterol. A prospective study was then carried out on gastric acid secretion and the subsequent development after 10 years of duodenal ulcers or dyspepsia.Young, healthy medical students have a fairly high mean basal and maximal acid output. There was very little difference in the mean acid outputs of the various ABO blood groups. A significant correlation was shown between acid output and body weight and fat-free body mass, but not with the other measurements of body build. Basal acid output was also related to the number of cigarettes smoked per day. Three students who subsequently developed duodenal ulcers all had a preexistent high level of acid secretion. The acid output was, however, similar in the groups who developed significant or minor dyspepsia or who remained asymptomatic.

Gastric mucosal stripping in the dog.

Aagaard, P., Andreassen, M., Simonsen, J., Olsen, J., Funding, J. & Fernandez, A. 1972. Gastric Mucosal Stripping in the Dog. Scand. J. Gastroent. 7, 219–224.Stripping of the gastric mucosa in an area corresponding to 50–75% of the body of the stomach was performed in 13 dogs. The stripping was done deep to the muscularis mucosae. Preoperatively the augmented histamine test was carried out. The dogs were followed for up to 16 months after the operation, and throughout this period the acid output was reduced. Autopsy revealed in the stripped area a low epithelium with a reduced number of parietal and pepsin-producing cells. There were no signs of fibrosis with shrinkage. After the operation some dogs had a fairly considerable weight loss. It has not been finally elucidated whether this operation is applicable in the treatment of duodenal ulcer in man.

The assessment of gastric acidity and appraisal of its clinical value.

Summary: Gastric intubation is necessary for the adequate assessment of gastric acidity. There is little place for the tubeless techniques. The most useful measurements are of acid concentration and secretion in the basal or fasting state and following maximal stimulation. The augmented histamine test has largely been replaced by the use of pentagastrin which has proved equally reliable and more acceptable to the patient. Indirect stimulation with insulin-induced hypoglycaemia is useful in selected patients following vagotomy. In patients with duodenal ulceration, acid secretion tests will be of value in only a small percentage of difficult diagnostic problems. There is no indication that they will assist the selection of the type of operation. Acid studies may be of value in the post-operative patient to assess the likelihood of recurrent ulceration. They are unreliable when used to differentiate benign from malignant gastric ulcers. When used in association with serum gastrin levels and measurements of gastrointestinal protein loss, gastric acid secretion studies may be of value in the differentiation of causes of hypertrophic gastric mucosa. They are of little clinical value however in other types of chronic gastritis. Newer techniques allowing measurement of back diffusion of hydrogen ions across the gastric mucosal barrier promise a better understanding of the pathogenesis of a variety of gastric diseases.

Influence of the number of parietal cells on risk of recurrence after truncal vagotomy and drainage for duodenal ulcer.

Relationships between pre- and postoperative augmented histamine test results and the risk of recurrence after truncal vagotomy and drainage for duodenal ulcer were demonstrated in 500 patients subjected to a complete follow-up. Men with a preoperative PAO ≥ 46.4 meq/h had a risk of recurrence of 14%, women with a PAO ≥ 42.2 meq/h, 28%. Below these levels the risk was 1.7 and 1.1% respectively. It was concluded that recurrence is not only caused by an incomplete vagotomy, since patients with a delayed positive Hollander response and recurrence had a higher parietal cell mass than those with a delayed positive Hollander response, but without recurrence. It is suggested that patients with duodenal ulcer and a high parietal cell mass (PAO ≥ 46.4 and 42.2) are subjected to antrectomy and vagotomy.

Prognostic value of the augmented histamine test in ulcer disease and x-ray negative dyspepsia.

108 patients with duodenal ulcer, gastric ulcer, or X-ray negative dyspepsia, were interviewed 24 to 52 months after an admission to hospital, where an augmented histamine test had been performed. In ulcer patients, who had only received medical treatment, no significant correlation was found between the acid production at the time of the admission and the severity of the symptoms at the follow-up interview. In X-ray negative dyspepsia a negative correlation was found. When those patients who had been treated surgically between admission and interview were taken into account, a positive correlation between PAO and severity of symptoms was found in female gastric ulcer patients, but in duodenal ulcer disease the augmented histamine test was still found to have no prognostic value.

VITILIGO, ACHLORHYDRIA, AND PERNICIOUS ANÆMIA

The gastric acid secretion was assessed in 102 consecutive vitiligo patients by means of the augmented histamine test. Achlorhydria was found in 20 patients. 8 of these 20 patients had pernicious anæmia, only 3 of the cases being known before the study. 19 of the 20 patients with achlorhydria and all 8 with pernicious anæmia were women. The frequency of achlorhydria in men with vitiligo was normal. Serum-vitamin-B12 was abnormally low in the patients with pernicious anæmia, low to normal in those with achlorhydria without pernicious anæmia, and normal in acid secretors. Antibody to gastric parietal cells was found in 80% of vitiligo patients with achlorhydria, compared to 6% of a normal group. Antibody to intrinsic factor was found in 3 patients, all of whom had pernicious anæmia. Insulin-dependent diabetes mellitus was found in 4 of the 102 vitiligo patients, and 6 had thyroid disease (including 2 women with Hashimoto's struma).

Gastric acid secretion in sickle-cell anaemia.

The gastric acid response to the augmented histamine test was measured in 115 Ghanaian patients, including 45 cases of sickle-cell anaemia. Normal gastric acid responses were found in the patients with sickle-cell anaemia, suggesting that the frequent occurrence of indigestion in patients with this disorder is unlikely to be related to abnormal gastric acid secretion.

Computed normal values for peak acid output based on age, sex and body weight.

The value of gastric analysis in the clinical management of patients with duodenal ulcer disease has been limited by lack of information on the expected normal gastric acid production following maximal stimulation. A table of peak acid outputs utilizing the augmented histamine test and based on age, sex and body weight of the individual was devised using the method of least squares.

Basal and Histamine-Stimulated Human Gastric Acid Secretion

The effects of indomethacin administration on gastric acid secretion were studied in 22 patients with arthritic diseases. Twelve patients had rheumatoid arthritis, 8 had osteoarthritis, and 1 each had Reiter's syndrome and ankylosing spondylitis. Augmented histamine tests were performed before and after a 1-month trial of the drug, administered in dosage of 75 to 100 mg per day. Repeated augmented histamine tests also were performed in 11 control subjects after a similar interval of time. No statistically significant changes in basal or histamine-stimulated gastric acid secretion were found in either the patients with arthritis or the control subjects.