• Also called as Gastric Acid/Juice

• A colorless to grayish or yellowish watery

fluid with a low specific gravity secreted
by the surface epithelium, gastric cells
and the various glands of the gastric tract.
• It is a medical procedure used to examine the
secretions and other liquid substances occurring
in the stomach.
• By means of a tube passed through the nose and
into the stomach, gastric fluid can be obtained
from the stomach.
• The most common reason for this test is to look
for blood in the upper gastrointestinal tract.
• Gastric fluid also can be cultured to testfor
tuberculosis if an adequate sputum sample
cannot be obtained for culture.
• Diagnosis of gastric diseases and assist in the
selection of therapy i.e. peptic ulcer
• It measures the amount of acid produced by a
patient w / symptoms of peptic ulcer.
• Diagnosis of Zollinger-Ellison syndrome
(adenoma of Islet of Langerhans) condition of
gastric hypersecretion produced by a gastrin
secreting tumor of the pancreas.
• Assess completeness of surgical vagotomy
• Determine of proper surgical procedure for
peptic ulcer treatment
 Cells responsible for production of
Gastric Fluid
03 types of cells:

• Chief or Peptic Cells

• producing the pr ot ein - split t ing
enzyme pepsin.
• Parietal or Oxyntic Cells
• producing HCl and Intrinsic Factor
(erythropoietic factor)
• Stimulated by Gastrin
• Goblet or Mucous Secreting Cells
• producing mucus f or the
protection of the mucosa and
lubricates the food.
Gastric Gland and Surface Pit from Body of the
Stomach
 Gastric Secretions
Substance Cells Region
HCl Pari Fundus-
etal Body
Cell
(Oxy
ntic
Cell)
Intrinsic Factor Parietal Fundus-
Cell Body
Pepsinogen- Chief Cell Fundus-
antrum Body

Mucus-Antrum Mucus Cell Fundus-

Body
1. HCl
2. Water
3. Mineral Acid-Acid Phosphatase
4. Electrolytes
▪ Ca, Ph, Mg, Na
5. Mucus
6. Digestive and Non-Digestive Enzymes
▪ Pepsin
▪ Gastrin
▪ Gastric Lipase
▪ RENNIN
▪ LDH, AST, ALT and Ribonuclease
7. Particles of Food- undigested and partly digested
 Done by Physician o r Well- Trained Personnel

The patient must be in a fasting state f or 1 2 - 1 5

hours with no medication during the last 24
hours.
Contamination with saliva neutralizes the gastric
acidity therefore i t should be prevented.
Should be resting and relaxed
Time specimen should be collected for the purpose
of comparison.
Using an evacuated tubes:
1. Levin tube – inserted in the nose
(nasal intubation)
1. Rehfuss tube – inserted in the m o u t h
(oral intubation)
A single lumen tube used f or stomach
decompressing, withdrawing specimens,
washing the stomach free of toxic substances
and irrigating the stomach and treat upper GI
bleeding.
Can also be used t o administer meds or f or
feeding.
Sizes: French 1 4 - 2 4
Length:125cm long
Nasogastric Levin Tube Levin Tube varies different colors,
Insertion depending on the lumen size.
A flexible tube that is used especially for withdrawing
gastric juice from the stomach for analysis and that
has a syringe at the upper end and an attachment with
a slot at the end passing into the stomach.
Small oral tube with a metal “oral tip” which helps the
patient to swallow the tube and by its weight, it falls
into the dependent portion of the stomach.
Used for gastric juice analysis and for emptying
stomach.
A tube with a calibrated syringe, formerly used
for aspiration of stomach contents in gastric analysis;
replaced by plastic disposable stomach tube's.
Insertion through Buccal
Rehfuss Tube
Cavity
 Methods of Collection

Tube or Intubation Method

• Gastric f l u i d is obtained by inserting a gastric
tube i n t o the stomach t h ro u g h buccal cavity o r
the nasal cavity.
Tubeless or Diagnex Blue Method
• An ion exchange resin coupled with a blue dye
(Azure A) is given orally.
• In presence of free gastric acid (HCl), Azure A
is released f r o m its resin binding in
exchange f or H + .
• Azure A is rapidly reabsorbed f r o m the
intestines and travels into the blood, t o the
kidneys and excreted in the urine
Pregnant female
Severely ill patients
Liver Cirrhosis
Esophageal Varices or Diverticulum
Stenosis or malignant tumor of the
Esophagus
Severe gastric hemorrhage
Cardiac Decompensation
Marked Arteriosclerosis
It is a means of gastric analysis based on the fact that
free hydrochloric acid releases a dye (Azure A) from a
resin base. Once the dye is released it is absorbed
from the intestinal tract and excreted in the urine.
If no hydrochloric acid is present in the stomach the
dye will not appear in the urine.
The test is valuable as a screening device to rule out
achlorhydria and is much less disturbing than other
methods of gastric analysis, which require the passage
of a stomach tube.
It does not, however, give conclusive evidence
sufficient for diagnosis of cases in which there is no
secretion of hydrochloric acid.
 PROCEDURE
Basal Gastric Secretion (BGS)
A tube is placed in the stomach for fluid collection to
measure the amount of secretion during 1 2 - 1 5 hours
fasting rate.
Four 1 5 - (or 30) minute specimens are collected and
volume, pH, titrated acidity and calculated acid
output is determined on each.
Total gastric secretion during this period is termed
as Basal Acid Output(BAO).
▪ The m inim um amount of gastric
hydrochloric acid produced by an individual
in a given period.
▪ Normal adult volume is 2 to 5 mEq/hr. or 0 - 6 m E q / h r
(Henry)
▪ It is used infrequently in the diagnosis of various
diseases of the stomach and intestines, such as gastric
ulcers and Zollinger-Ellison syndrome.
• Involves stimulation of fluid formation through
the use of Stimulants.
• Total acid secreted in the hour after
stimulation is Maximal Acid Output (MAO).

• The total acid secretion for the period of 60 min

after administration of a gastric stimulant that
cannot be increased by higher doses of the
stimulant.
• Normal Value: 5 - 4 0 m Eq / h r (Henry)
 Gastric Stimulants

• Histamine
• Pentagastrin
• Histalog(Betazole)
 TEST MEALS
Ewald’s Meal ( Break fast)
• Bread and tea w i t h o u t sugar or water.
• Routinely used.

Boas
• Oatmeal
• Recommended f o r lactic acid

Reigel
• Beef steak and mashed p otato.
• Recommended f o r d ete ction of Achylia and
Hypoacidity.
 What is Achylia?
Absence o f gastric juices.

What is Hypoacidity?
Lower than normal degree of acidity
 Gastric Juice, Typical Reference Values

Fasting Residual 20-100ml

pH <2
Basal Acid Output 0-6mEq/hr
(BAO) (mmol/hr)
Maximum Acid 5-40mEq/hr
Output (MAO) (mmol/hr)
BAO/MAO ratio <0 .4
 Normal Gastric Fluid

Appearance Translucent, Pale Gray and slightly viscous,

NO food, blood, drugs or bile present

Volume 5 0 -75ml
Odor Faintly Pungent
pH 1.6-1.9 (1.5-3.5)
Mucus Separates into 3 layers *on standing
Specific 1.001-1.010 average of 1.007
Gravity
 Normal & Abnormal Gastric Analysis
Results

Conditions BAO MAO BAO/MAO

Normal 2.5 25 10
Pernicious Anemia 0 0 0

Duodenal Ulcer 5 30 17
Zollinger-Ellison 18 25 72
Syndrome
 Abnormalities in Color
Color Significance
Yellow to Bile which is occasionally regurgitated in the
Green normal stomach and frequently
accompanies excessive gagging during
intubation.
Red Blood from minor trauma during intubation.
Coffee Ground Old blood (from gastritis, ulcer or
carcinoma or swallowed from the mouth,
nasopharynx or lungs).
Opaque Gray Seen after a test meal.
Yellow Presence of fresh bile.
Greenish Presence of old bile.
 Abnormalities in Odour
Odor Significance

Fecal Odor (+) in intestinal obstruction or gastro-

colic-fistula

Foul or Putrid (+) in carcinomatous ulcer

Odor
Alcohol Odor (+) in alcohol coma or after alcohol
test meal
Ammoniocal Odor (+) in cases of uremia

Rancid Odor Due to butyric (fatty acid) and lactic

acid
Present in sour milk-indicating
stenosis and fermentation
 Abnormalities in Volume
Fasting State 20-50mL

After a Test Meal 20-80mL

Chemical Stimulant 45-150mL

Volume should be:

Increased in: Hypomotility, pyloric
obstruction, Z-E Syndrome

Decreased in: Gastric Hypermotility

Chemical Examination of Gastric Fluid
Total Acidity HCl+combined
acids = 4 0 -
70mEq/L
Free HCl 20-40mEq/L
Free Acidity Free HCl, organic
acids and acid
salts.
Normal pH 1.6-1.8
High Acidity 1.4 or lower
Low Acidity 2.0 or 2.8
 Euchlorhydria Normal gastric Acidity
Achylia Absence of all acids
Anacidity Failure of the stomach acidity to fall lower
than 6.0 in a stimulation test.

Achlorhydria Physiologic failure of pH to fall below 3.5

or 1.0 pH unit with gastric stimulation.
Absence of free HCl

Hypochlorhydria Physiologic failure of pH to fall below 3.5,

although it decreases 1.0pH unit or more
upon gastric stimulation
Decreases free HCl

Hyperchlorhydria Increase free HCl above normal.

Microscopic Examination
of
Gastric Juice
 Normal Structure Pathologic Structure

Yeast Cell-small amount Fragments of Tissues

Epithelial Cell
RBC

Starch Granules
Yeast-large amount

Bacteria-lesser amount
Pus Cell

Fat Globules/Droplets
Muscle Fibers

Food Remnants
Bacteria-large amount
 Tests for free HCL
Diagnex Blue Method
Boa’s Method
Topfer Method
• Reagent: Dimethylaminobenzene 0.5gm,
95%Ethanol 100ml
• used for titration of acid with 0.1 N sodium
hydroxide and phenolphthalein.
Gunzberg Method
• Gunzberg's reagent is made by dissolving two
grams of phloroglucinol and one gram of
vanillin in 100 millilitres of 95% ethanol.
Hydrochloric acid catalyses Gunzberg's
reagent to form a red complex.
• Procedure: Two drops of gastric juice are mixed
with two drops of Gunzberg's reagent in an
evaporating dish. The mixture is evaporated and
if red is seen, free hydrochloric acid is present.