Augmented Histamine Test Research Articles

Augmented histamine test for gastric acid secretion —Clinical survey of 2356 CASES—

Augmented histamine test for gastric acid secretion —Clinical survey of 2356 CASES—

Augmented histamine test in the treatment of symptomatic hiatal hernia.

The augmented histamine test was performed in 150 cases of oesophageal hiatal hernia with and without duodenal ulcers and the results have been analysed. There was no significant difference in the result compared with normals. In addition there is no correlation between the acid secretion and either symptoms or size of the hernia. The pathogenesis of heartburn is briefly discussed.

Acute gastric mucosal lesions produced by augmented histamine test.

Twenty patients were gastroscoped and subjected to suction biopsy of fundic mucosa under gastroscopic control before and after administration of augmented histamine stimulation preceded by an antihistamine.

Role of the vagus nerves in the physiology of gastric secretion

The vagus nerves play a dominant role in the stimulation of gastric secretion. The basal or continuous secretion of gastric juice in normal man and animals is almost entirely caused by tonic impulses in the vagus nerves. The hormonal mechanism for the stimulation of gastric secretion is almost entirely quiescent when there is no food in the stomach or duodenum. Food taking causes an immediate and profound stimulation of gastric secretion. Impulses in the vagus nerves are aroused reflexly by the sight, odor, and taste of palatable food. These impulses release acetylcholine at the endings of the vagus fibers in the stomach wall and the transmission of the nervous impulse to the acid- and pepsin-producing cells is probably done by this humoral agent. If the gastric content in contact with the antral mucosa is not acid in reaction, the vagus impulses also cause a small release of gastrin into the circulation which is sufficient to potentiate the stimulating effect of the vagus impulses on the parietal and chief cells. The suggestion that both gastrin and vagus impulses release histamine and that histamine serves as a final common pathway for both of these types of stimulation seems improbable. Gastric juice secreted in response to vagus stimulation is rich in pepsin, that secreted in response to histamine stimulation is poor in pepsin, and that secreted in response to gastrin is intermediary in compositon. If the final agent for all three is assumed to be histamine, these differences in the composition of the gastric secretion should not occur. A profound increase in the basal or continuous secretion of gastric juice occurs regularly in patients with duodenal ulcer. This is of sufficient magnitude so that if a comparable hypersecretion is induced in animals, chronic peptic ulcers are produced. The basal hypersecretion is of vagus origin and is abolished if all or nearly all of the vagus fibers to the stomach are divided. Failure to divide all of the vagus fibers may result in persistence of hypersecretion and failure of the ulcer to heal. This suggests that some intermediary mechanism, possibly Meissner's plexus, exists between the efferent vagus fibers and the parietal cells so that even a small vagus branch can activate the entire glandular apparatus. In long-standing duodenal ulcers the number of acid-secreting cells in the stomach may be twice or more the normal amount. This increase in the parietal cell mass probably accounts for the increased secretory response of the duodenal ulcer patient to the augmented histamine test as well as to the increased response to the test meals of the early gastroenterologists. There is still some difference of opinion with respect to the cause of basal hypersecretion of gastric juice in duodenal ulcer patients. I believe it is due to a secretory hypertonus in the vagus nerves in turn produced in some way by the tensions, emotional strains, and competitive efforts of modern life. It is in this way that the central nervous system plays its role in the pathogenesis of the disease and in this sense duodenal ulcer may be considered a psychosomatic disease. Evidence for this hyperactivity in the vagus secretory apparatus is entirely indirect. We have observed that basal secretion in duodenal ulcer patients on the night before a surgical operation is almost always twice as much as that during other periods. This could be caused by anxiety and apprehension of the approaching surgical ordeal. It could not be caused by an increase in the parietal cell mass developing in such a short time. Exacerbation of duodenal ulcer symptoms with hemorrhage and perforation reported from English cities during the bombing raids in World War II are also in harmony with this view. Similar exacerbation of symptoms in duodenal ulcer patients during periods of emotional conflict and stress has for a long time been commented upon in the literature. In my experience determination of the basal secretion has been useful in selecting patients for surgical versus medical treatment and in determining the prognosis after surgery. When the basal secretion exceeds three to four times the normal values, the prospect for permanent cure of a duodenal ulcer by medical treatment is remote and surgery should be advised. If basal hypersecretion persists after surgery, recurrence of the ulcer should be anticipated.

Gastric secretion of acid and intrinsic factor in patients with hyper- and hypothyroidism.

Abstract Fifteen consecutive thyroid disease patients, ten with hyperthyroidism and five with hypothyroidism, have been investigated as far as gastric secretion was concerned. Gastric secretion of acid and intrinsic factor was studied in the patients both basally and with the augmented histamine test. In eight patients with hyperthyroidism and all patients with hypothyroidism, the gastric secretion of acid after histamine stimulation was significantly lowered. The secretion of intrinsic factor correlated with the secretion of acid, and was significantly depressed in four patients with hyperthyroidism and three with hypothyroidism. Further studies showed pernicious anemia in two patients with hypothyroidism.

Diagnostic value of the augmented histamine test in cancer of the upper part of the stomach.

By the use of Kay's augmented histamine tes ton 87 patients with gastric cancer, it was demonstrated that patients with cancer affecting the upper third of the stomach have preserved acid secretion significantly more often than patients with cancer of the lower two-thirds, and 4 out of 30 patients with cancer in the upper third of the stomach secreted more than 20 mEq H+/h. Patients with free acid do not appear to show variations in the quantity of acid according to the anatomical situation of the tumour. Preserved acid secretion in the augmented histamine test does not rule out the possibility of gastric cancer, especially not cancers situated in the upper third of the stomach.

Correlation between gastric acid secretion and histology in Indian subjects.

Gastric biopsy was performed on 102 subjects comprising: control subjects (25), patients suffering from vague gastrointestinal symptoms (42), tropical sprue (24) and iron deficiency anaemia (11). The correlation between histology of gastric mucosa and acid output on augmented histamine test (AHT) was studied in 51 subjects and on histamine-infusion test (H-I.T) in 69 subjects. A good correlation was observed between histology of gastric mucosa (single biopsy) and acid output both on A.H.T and H-I.T. Furthermore, in subjects from India showing normal gastric mucosa, acid output on H-I.T. was found to be comparable to that reported in patients from Britain but comparatively lower values were observed on A.H.T.

The incidence of achlorhydria and hypochlorhydria in healthy subjects and patients with gastrointestinal diseases.

One hundred and seventy healthy subjects and 1881 patients with gastrointestinal diseases were examined with the augmented histamine test. Achlorhydria and hypochlorhydria were defined by a pH in gastric juice higher than 3.3 after stimulation in combination with a pH fall less, or more, than one pH unit during the test. The incidence of achlorhydria was 4.7 per cent in healthy subjects and 6.4 per cent in patients, and the incidence of hypochlorhydria was 4.1 per cent in healthy subjects and 3.8 per cent in patients. Both secretory defects were uncommon in subjects younger than 50 years of age. The incidence of achlorhydria in patients increased rapidly from 1.8 per cent in the fifth decade to 18.5 per cent in the eighth decade, and a similar increase was observed in healthy subjects. No sex differences were found. Seventy five per cent of achlorhydric and 68 per cent of hypochlorhydric subjects were observed in patients with pernicious anemia, gastric cancer, postoperative stomach or gastritis. The inci...

Psychotherapy and medical treatment for duodenal ulcer compared using the augmented histamine test

Psychotherapy and medical treatment for duodenal ulcer compared using the augmented histamine test

Estimation of maximal gastric acid secretory capacity after augmented histamine stimulation.

One hundred and eighty-two patients with gastroduodenal diseases and 35 healthy subjects were examined with the augmented histamine test, and five normal volunteers were examined after maximal subcutaneous and intravenous histamine stimulation in a total of 43 tests and dose-response experiments. The different estimates of the maximal gastric acid output in the augmented histamine test and the histamine infusion test are compared.In clinical practice, the augmented histamine response, calculated from the 15-45-minute period of the augmented histamine test with subcutaneous stimulation, offers a valid, repeatable, and efficient estimate of the calculated maximal acid secretory capacity and the parietal cell mass, not surpassed by any other estimate, calculated from other 15-minute outputs or with use of other gastric secretory stimulants. It is recommended that the augmented histamine response calculated from the 15-45-minute period of the augmented histamine test with subcutaneous stimulation should be us...

Zollinger-Ellison Syndrome Comes of Age

The non-beta islet cell tumor of the pancreas is associated with a variety of clinical symptoms. These tumors as well as their metastases can produce a potent gastrinlike hormone responsible for marked gastric hypersecretion and a fulminating ulcer diathesis, with or without diarrhea. Less commonly, these tumors may be associated with a severe diarrhea in the absence of gastric hypersecretion or peptic ulceration. The relatively fixed concentration of hydrochloric acid in the control and following the augmented histamine test and the Lai rat bioassay can be of diagnostic value. The potential of the non-beta islet cell tumor of the pancreas to produce more than one hormone is suggested from the case reports. The treatment of peptic ulcer may eventually be improved by systemic measures designed to control the hormones responsible for gastric hypersecretion.

Gastric acid secretion and succinic dehydrogenase in parietal cells, with special reference to the effect of anticholinergic drugs.

Forty-five patients with various gastroduodenal disorders and 5 healthy subjects were examined by augmented histamine test and single gastric biopsy. Using MTT reagent, the succinic dehydrogenase-active parietal cells were stained in cryostat-cut sections, 7 microns thick. The maximal acid secretion (mEq H+ per hour) was significantly correlated to the number of succinic dehydrogenase-active parietal cells per unit of gastric mucosa, to the size of the parietal cells, and to the thickness of the parietal cell layer. Using the same methods, these correlations were also demonstrated among twenty-six patients in whom the gastric acid secretion had been lowered by gastric surgery (6 patients) or by administration of Glycopyrrolate, an anticholinergic drug (20 patients). Fifteen patients were examined before and after subcutaneous administration of Glycopyrrolate with an interval of two days. In these patients the fall in acid secretion after the administration of Glycopyrrolate was significantly correlated to...

Elective surgery for duodenal ulcer.

A study has been made of the value of the augmented histamine test with medical vagotomy in pre‐selecting the most appropriate operation for any individual patient requiring elective surgery for duodenal ulcer. One hundred consecutive patients were studied. The selection procedure altered the otherwise preferred operation of vagotomy and gastro‐jejunostomy in only eight cases—five patients being treated by vagotomy and anirectomy and three by partial gastrectomy. The results are discussed, and it is concluded that the use of these tests as a preoperative selective procedure is unjustified. Copyright

Dehydrogenase activity and gastric secretion in gastritis.

In 43 adults suction biopsies from the fundus or the body of the stomach were obtained with a Crosby-Kugler's biopsy capsule.One-half of the biopsy specimen was fixed in formalin, embedded in paraffin and stained with H & E. Cryostat sections from the other half of the specimen were incubated with Nitro-BT and the specific substrate to demonstrate the activity of SD, NAD, and NADP, respectively. An augmented histamine-test was performed in all patients after an overnight fast.In 10 patients with normal gastric mucosa the activity of SD, NAD, and NADP was most pronounced in the parietal cells.In 18 patients with superficial gastritis a similar or slightly decreased dehydrogenase activity was observed, and the secretion of gastric juice and hydrochloric acid did not differ significantly from that found in the subjects with normal gastric mucosa.Except for a markedly reduced NAD activity in the surface epithelium, slight or no reduction of the dehydrogenase activity was observed in the eight patients showing...

Gastric secretory patterns before and during treatment with 1-hyoscyamine.

Ten male patients with chronic duodenal ulceration were examined with an augmented histamine test before and during treatment with optimal effective doses of long acting 1-hyoscyamine. The outputs and secretory patterns for volume, acid, pepsin, and intrinsic factor were determined. The basal and stimulated secretion of volume and acid were significantly reduced during treatment, while the pepsin and intrinsic factor secretion were virtually unaltered. The results of acid secretion were compared to those after effective surgical vagotomy. The reduction in acid output after vagotomy was in all patients except one more pronounced than during treatment with 1-hyoscyamine.

The radiological assessment of gastric acid output.

The augmented histamine test (1) and the maximum histalog (betazole) stimulation (2, 3) (MHS) are accepted as the standard procedures for measurement of gastric acid output. Their main clinical value lies in the finding of achlorhydria (or minimal acid secretion) and exceedingly high acid. Gastric mucosal atrophy is commonly associated with achlorhydria, and increased rugosity of the stomach with coarse duodenal folds is frequently seen in patients harboring non-beta cell tumors of the pancreas (4) or those with high gastric secretion with or without a demonstrable ulcer (5). Recently, attention has been drawn to the fair correlation existing between the gastroduodenal mucosal pattern and the gastric acid output (5, 6). This study was undertaken to see if it is possible to assess gastric acid secretion in different disorders on the basis of a radiological examination of the stomach and duodenum and to test the reliability and reproducibility of such estimation. Material and Methods 1. Measurement of Gastr...

Results of Augmented Histamine Tests

Results of Augmented Histamine Tests

Measurement of Gastric Hydrochloric Acid after Maximal Histamine Stimulation with Special Reference to Achlorhydria

Titration to different pH end points was performed in all samples of gastric juice from 208 patients with gastro- instestinal diseases and healthy persons, examined with the augmented histamine test. Titration to pH 3.3 and to pH 7.0 revealed differences in hydrogen ion concentration, which were significantly negatively correlated to the maximal acid output, calculated from the acidity at pH 3.3. Differences between maximal acid outputs, calculated from the acidities at pH 3.3 and pH 7.0, varied only little in all examined groups with the exception of gastric juice contaminated by food. Titration to pH 7.0 or higher overestimates gastric hydrochloric acid, especially in gastric juice from patients with gastritis and gastric juice contaminated by food. The results of this study support previous investigations, which recommend titration of gastric juice to pH 3.5 with simultaneous measurement of pH. Achlorhydria corresponding to absence of parietal cells is hereby defined by a pH higher than 3.5 and a pH fall less than one pH unit from basal to maximally stimulated values.

Acid, alkaline, and peptic secretion in chronic gastritis.

In this study, 1023 patients ranging in age from 13 to 78 years were examined. Two blind biopsies of gastric mucosa were obtained in each patient. Acid secretion was measured by means of the augmented histamine test. Gastric alkaline and peptic secretion as well as uropepsinogen levels were determined at the same time.

VARIABILITY OF GASTRIC SECRETION IN PATIENTS WITH AND WITHOUT THE ZOLLINGER-ELLISON SYNDROME

Data from repeated gastric secretory studies (augmented histamine tests, 12-hour overnight tests) in eight patients with peptic ulcer are presented. Four patients had proven Zollinger-Ellison syndrome; in the other four this diagnosis was suspected but could not be confirmed at surgery. In seven patients, striking variations in the secretory patterns were observed on repeated testing. The basal secretion exhibited the widest fluctuations resulting in important alterations in calculated ratios of basal to stimulated secretion. Several of the investigations failed to suggest the correct diagnosis or suggested an erroneous diagnosis, while tests in the same patients performed at different times were often consistent with the correct diagnosis. Caution is therefore warranted in the interpretation of gastric secretory data in any patient in whom the Zollinger-Ellison syndrome is suspected.