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Gastric juice in pernicious anemia

Physicochemical composition of gastric juice in complete achlorhydria and composition of primary alkaline secretion of the stomach

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Summary

The physicochemical composition of the gastric juice of 16 patients suffering from pernicious anemia was determined. The study of the relationship between chloride, sodium, and alkalinity showed that gastric juice in these patients has the same characteristics as the primary alkaline secretion of a patient with a normal stomach. The stomach of a patient with Biermer's disease, from the biologic point of view, appears to be one that has been deprived of its acid (parietal cells) and peptic (chief cells) functions and, on the other hand, has retained normal glands of alkaline secretion.

The values of primary alkaline secretion determined in the study reported here seem to be more realistic than those obtained mathematically by Hollander, Gray and Butcher, in dogs, and Hunt, in humans.

A better knowledge of the composition of the primary alkaline secretion makes possible—without recourse to measurement of thepH or administration of large doses of histamine, which are not always tolerated in spite of the use of antihistaminics—a simple distinction between absolute achlorhydria of cellular origin, which is characteristic of Biermer's disease, and relative or chemical achlorhydria, which disappears under the influence of certain drugs that increase the concentration of acid in the gastric juice (corticoids or larger doses of histamine). In patients having so-called achlorhydric gastric juice, the two types may be distinguished, according to Töpfer, by determination of the total alkalinity of the samples taken during intubation in stages. An alkalinity curve that does not change after injection of the usual dose of histamine dihydrochloride (0.5 mg.) indicates true achlorhydria of the Biermer type, and an alkalinity curve that reflects declining values signifies chemical achlorhydria.

Cellular achlorhydrias are very rare other than in Biermer's disease; of a total of 73 patients with achlorhydrias without anemia, the authors observed 5 cases, 3 associated with cirrhosis with ascites and 2, in the course of early gastritis.

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Authors and Affiliations

  1. From the Gastro-enterological Research Centre, Hôpital Bichat, Paris, France

    A. Lambling, J. J. Bernier, Y. Najean & J. Badoz-Lambling

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  1. A. Lambling
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  2. J. J. Bernier
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  3. Y. Najean
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  4. J. Badoz-Lambling
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Lambling, A., Bernier, J.J., Najean, Y. et al. Gastric juice in pernicious anemia. Digest Dis Sci 6, 629–645 (1961). https://doi.org/10.1007/BF02232337

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