J. Gershon-Cohen

A self regulatory duodenal mechanism for gastric acid control and an explanation for the pathologic gastric physiology in uncomplicated duodenal ulcer.

By a direct approach in the human subject we have demonstrated the presence in the normal duodenum of a mechanism which is brought into play by a concentration of acid peculiar to the individual. This concentration for any meal, is represented by the peak of free acidity reached after the particular meal. When this concentration of acid reaches the duodenum a mechanism is activated that depresses gastric secretion and is responsible for the descending limb of the normal gastric curve. In the failure of the normal response of such a mechanism, obtunded by the ulceration and inflammation produced by duodenal ulcer, we believe lies the explanation for the high acid extra-gastric curve seen in this disease. That such a failure of response does occur, we have demonstrated in duodenal ulcer patients. If we combine our present findings regarding gastric secretion with the influence of the duodenum upon gastric motor function which we have previously described, we have for the first time, in the disturbance of one mechanism an explanation for the characteristic clinical gastric findings in uncomplicated duodenal ulcer—hyperperistalsis, hypertonicity, hypermotility and hypersecretion.

Concerning the influence of glucose on the response of the human stomach to test meals

With a two tube technique in man, the influence of glucose solutions instilled intraduodenally and intravenously upon the response of the stomach to test meals was investigated. An attempt was made to separate the duodenal effect upon gastric acidity resulting from the osmotic changes produced by hyper-tonic glucose and the possible effect of the resultant hyperglycemia. Our evidence at present indicates the most striking effect to be dependent upon the altered osmotic conditions in the duodenum, while the hyperglycemia plays only a secondary role. The latter, however, may be sufficient to explain the higher-than-average incidence of anacidity in diabetes.

THE RÔLE OF THE UPPER SMALL INTESTINE IN THE CONTROL OF GASTRIC SECRETION; THE EFFECT OF NEUTRAL FAT, FATTY ACID, AND SOAPS; THE PHASE OF GASTRIC SECRETION INFLUENCED AND THE RELATIVE IMPORTANCE OF THE PSYCHIC AND CHEMICAL PHASES

Excerpt The prohibition in Leviticus†: Ye shall eat no manner of fat, of ox, or of sheep, or of goat, might mean that the ancients were aware of the retardation of gastric digestion by fats. Cert...

Experimental studies in gastric physiology in man: the mechanism of gastric evacuation after partial gastrectomy as demonstrated roentgenologically.

Partial gastric resection apparently causes no basic changes in gastric evacuation. If the altered gastric chemistry which results from the resection is taken into consideration, then gastric evacuation is modified in the same way by the same agents that modify gastric-emptying of the intact stomach to a similar chemical response, except, of course, for quantitative differences. These differences appear to be due to the loss of the pyloric sphincter. The remaining gastric muscle-fibers appear to offer a substitution mechanism, but are not so efficient as was the pylorus. The response is similar to that of the intact stomach whether the test substances are ingested or are applied directly to the intestinal mucosa. The evidence also indicates that, even in a partially resected stomach, the mechanism of gastric evacuation is controlled from the intestinal side.

THE EFFECT OF DUODENAL STIMULATION IN MAN UPON ALIMENTARY AND ADRENALIN HYPERGLYCEMIA

Excerpt As early as 1825, Leuret and Lassaigne33from studies on the horse and dog wrote that the causes which determined the secretion of pancreatic juice were analogous to those which influenced t...

The absorption of hydrochloric acid by the human stomach

We were able to study the question of HC1 absorption in man by inducing sufficient duodenal stimu lation to arrest gastric evacuation and by using phenol red as an indicator of that arrest. This was possible because phenol red in concentration of two milligrams per 100 cc. is not absorbed by the human stomach. Hydrochloric acid in concentrations of approximately 0.5% or 1% is not absorbed by the stomach when such solutions are in contact with it for periods up to 30 minutes. Hydrochloric acid meals of 0.5% concentration do not completely inhibit gastric secretion, while 1% meals do cause complete inhibition.

A THEORY EXPLAINING THE LOCAL MECHANISM FOR GASTRIC MOTOR AND SECRETORY CONTROL AND THE ALTERATION OF THESE FUNCTIONS IN UNCOMPLICATED DUODENAL ULCER

Excerpt The symptomatology of duodenal ulcer is due in large part to the disordered gastric physiology. It is also true that if an adequate explanation for the disordered physiology were available,...

The factor of occult hepatic and biliary tract disease in some cases of allergy

Experimental anaphylaxis in the dog yields adequate evidence for the role of the liver in the shock produced in this animal. There is also some indirect evidence in the literature of human allergy that disturbed liver function may play an important part in some cases. Our own studies indicate that occult liver and gall bladder disease may sometimes be of primary importance. Stimulation of the liver cell by intravenous Decholin therapy and the removal of a diseased gall bladder have yielded strikingly good results, usually in patients who showed evidence of liver dysfunction, objectively. A working hypothesis is offered to explain the satisfactory results obtained. We would urge a study of the liver and biliary tract as part of the diagnostic survey of the allergic patient.

The effect of osmotic changes in the small intestine upon gastric emptying in man.

For the same reasons that we concluded the pyloric action was motivated locally through duodenal stimulation by chemical action, we conclude that this same mechanism is influenced by physical stimuli as represented by changes in osmotic pressure away from isotonicity. Gastric emptying time alone cannot be used as an index of pyloric function when considering osmotic tension of agents given by mouth because of the migration of fluid which takes place through the stomach wall when the test meals are not isotonic.

A COMPARISON OF THE EFFECTIVENESS OF GLUTAMIC ACID HYDROCHLORIDE AND DILUTE HYDROCHLORIC ACID AS THE REPLACEMENT THERAPY IN ANACIDITY MEASURED BY FRACTIONAL GASTRIC ACID TITRATION AND HYDROGEN-ION CONCENTRATION CURVES

Excerpt For the most part, anacidity has been regarded an interesting but scarcely serious medical curiosity. In the absence of gastric carcinoma, or of blood changes suggestive of Addisonian anemi...