Harry L. Segal

Determination of gastric acidity without intubation by use of cation exchange indicator compounds.

Summary The preparation of a cation exchange indicator compound called quininium resin indicator compound has been described. The rationale and method of its use have been stated. In vitro tests have demonstrated that the quininium cation present in this compound will be displaced by the hydrogen ions of dilute hydrochloric acid solutions and of the gastric juice. In vivo experiments have shown that, by administering this cation exchange resin indicator compound orally and noting the time of appearance of the quininium cation in the urine, the presence or absence of free hydrochloric acid in the gastric juice can be determined without subjecting the individual to intubation.

Gastric cancer--increased frequency in patients with achlorhydria.

This paper reports the difference noted in the frequency of gastric carcinoma in “achlorhydrics” as opposed to acid secretors in a follow-up study of 1590 individuals over 40 years of age in whom the state of gastric acidity was determined by tubeless gastric analysis with the azure resin compound and caffeine as the gastric stimulant. The authors describe the rationale of this tubeless gastric analysis technic with caffeine as the gastric stimulant and emphasize that “achlorhydria” as determined by this method indicates an abnormal gastric mucosa. Gastric carcinoma occurred in 3 of the 906 acid secretors (0.33%) and in 16 of the 684 achlorhydric individuals (2.3%) detected by the tubeless gastric analysis technic. The data show that the frequency of gastric carcinoma was about 7 times greater in the achlorhydric group than in the acid-secreting individuals. The increased incidence of achlorhydria from 19% in the fifth decade of life to 69% in the eighth decade suggested that an abnormal gastric mucosa may be a common accompaniment of aging. The increased occurrence of an abnormal mucosa was associated with a rise in frequency of gastric carcinoma from 1.6% in the fifth decade to 3.4% in the eighth decade. By contrast, the lower incidence of gastric carcinoma in acid secretors in the older age groups is probably related to an essentially normal gastric mucosa. Although the incidence of achlorhydria in the O and A blood groups was approximately equal (60% of the individuals in each blood group had achlorhydria) the frequency of carcinoma was about 4 times greater in subjects with blood group A than in those with blood group O.

Gastric secretory derangement in Menetrier's disease. Report of two cases.

SummaryTwo cases of Menetriers disease with occult gastrointestinal albumin loss, absence of free hydrochloric acid, and increased uropepsinogen excretion are presented.The absence of free hydrochloric acid is explained by the combination of edema and inflammatory reaction interfering with passage of the hydrochloric acid into the gastric cavity and its neutralization by the increased amount of albumin exuded into the stomach.The decrease in gastric pepsinogen secretion associated with an increased uropepsinogen excretion is probably due to a derangement of the normal exocrine-endocrine partition.

Enzyme histochemical studies of human gastric and jejunal biopsy specimens in normal and disease states

SummaryThe alkaline phosphatase activity of 28 gastric and 32 jejunal biopsy specimens examined histochemically revealed the following:(1)absence of alkaline phosphatase activity in normal gastric mucosa and in mucosa with varying degrees of gastritis unassociated with intestinal metaplasia;(2)marked alkaline phosphatase activity in the brush border region of the metaplastic cells in 3 patients with gastritis associated with intestinal metaplasia; and(3)no significant difference in alkaline phosphatase activity between the jejunal biopsy specimens of normal patients and those with primary malabsorption syndrome. The trimetaphosphatase activity of 24 gastric and 32 jejunal biopsy specimens examined histochemically showed:(1)no significant difference in trimetaphosphatase activity between stomach biopsy specimens with normal histology and those from patients with varying degrees of gastritis; and(2)no significant change in trimetaphosphatase activity between the jejunal biopsy specimens of normal patients and those with primary malabsorption syndrome;(3)the variability of trimetaphosphatase activity in the human stomach and jejunum does not allow differentiation between normal and disease states but may reflect transient differences in local activity between different areas selected for biopsy.

Gel filtration of vitamin B12-binding materials from human gastric juice and gastric mucosa

Abstract 1. 1. In the course of experiments to isolate human intrinsic factor, its behavior on gel filtration through Sephadex G-100 at pH 7.3 was compared with that of the vitamin B12-intrinsic factor complex from human gastric juice and gastric mucosa, and with bovine serum albumin and human hemoglobin. 2. 2. The vitamin B12-binding materials of neutralized gastric juice showed the same elution pattern whether the vitamin B12 was added before or after gel filtration. This pattern was the same as that obtained from gastric mucosal homogenates with added vitamin B12. Two peaks of vitamin B12-binding material were found, a small initial one comprising some 15–20% of the total vitamin B12-binding activity of the specimen and a second peak representing 80–85% of the activity. 3. 3. The first peak gave no reaction in a specific radioimmunodiffusion assay for intrinsic factor. 4. 4. The second peak gave a strong reaction for intrinsic factor in the radioimmunodiffusion assay and its vitamin B12-binding activity could be completely abolished by specific antibody, indicating that it was composed entirely or almost entirely of intrinsic factor. 5. 5. The intrinsic factor showed a distribution coefficient of 0.198 in this column, the same as bovine serum albumin. Since deviation from sphericity of the intrinsic factor and the presence of carbohydrate in the molecule would produce an overestimation of the molecular weight, it is probable that the molecular weight of the intrinsic factor has an upper limit of 65000–70000. There was no evidence for the presence of any intrinsic factor material of higher molecular weight than this either in the gastric mucosa or neutralized gastric juice. 6. 6. Addition of vitamin B12 to the intrinsice factor did not alter its gel filtration behavior indicating that the binding of vitamin B12 did not produce any gross changes in the molecule. 7. 7. The gel filtration with Sephadex G-100 gave a 10-fold purification of the intrinsic factor from gastric juice which was obtained in a yield of 80%.

Pepsinogen I in Semen. Chromatographic Separation of Pepsinogen I from Human Semen.

Summary Fractionation of human semen on DEAE (diethylaminoethyl)-cellulose has shown that the seminal proteolytic activity at low pH is eluted as a single peak of proteolytic activity. This peak of proteolytic activity exhibits no milk clotting activity unless it is first activated by acidificaton. The chro-matographic mobilities of the proteolytic activity at low pH of unacidified and acidified semen are similar to those of unacidified and acidified gastric mucosal pepsinogen I, respectively. The possible conversion of seminal pepsinogen to pepsin by weakly acidic vaginal secretions posed the question of a possible role for pepsin in human reproduction.

The effect upon gastric secretion of introducing dilute hydrochloric acid into the duodenum. A study of normal humans and duodenal ulcer patients.

HC1 in 0.4% solution or in gastric juice, when introduced into the duodenum of normal subjects, had no constant, significant effect on gastric secretory curve.

Pepsin secretion in man after Histalog stimulation

Human gastric juice shows three separable pepsin fractions on chromatography on DEAE-cellulose. The response of these fractions to stimulation with β-aminoethylpyrazole hydrochloride (Histalog) was studied. After a single intramuscular injection of Histalog (1·7 mg/kg body weight) there was an increase in the output of all three chromatographically distinguishable pepsin fractions. Little change was observed in the relative proportions of these three fractions and there was no evidence of selective stimulation of any individual fraction.

TUBELESS GASTRIC ANALYSIS AS A TOOL TO MEASURE GASTRIC SECRETORY ACTIVITY

This report discusses the tubeless techniques available to evaluate the capability of the gastric mucosa to secrete acid, pepsinogens, and intrinsic factor. The presence of gastric acid can be determined by proper application of the azure A ion‐exchange resin technique. Pepsinogen and intrinsic factor activity may be inferred from measurement of the urinary pepsinogens and the absorption of an oral dose of radioactive vitamin B12 with or without added intrinsic factor, respectively. A normal serum vitamin B12 level may be present in a patient with a recent failure of intrinsic factor secretion: however, a decreased level is suggestive of the absence of intrinsic factor in individuals who have no evidence for malabsorption. The value of the rapid charcoal method developed in Herberts laboratory for measuring serum vitamin B12 is discussed.

A polyamine formaldehyde resin. IV. Clinical evaluation in the treatment of duodenal ulcer.

The literature concerning the use of an anion exchange resin in the treatment of peptic ulcer has been reviewed.