Probe methods of investigation of the stomach

Simultaneous study of gastric secretion

With thick aspiration probe simultaneously extracted stomach contents, is a mixture of gastric juice and bread test meal, whereby often receive inaccurate data regarding the quantity and quality of secretion. This drawback of this method. However, to completely abandon its use should not be, because in those cases, when the use of more sophisticated methods of investigation can not be, This method gives the doctor although indicative, but very valuable information about the secretory and motor-evacuation of the stomach.

Fractional study of gastric secretion

Among the existing variety of methods of fractional study of gastric contents noteworthy methods of obtaining pure gastric juice. Modern methods of research of gastric secretion based on the works of H. AND. Leporskogo.

Probing for Leporskaya It makes it possible to obtain in pure form "serial" gastric juice. Currently, research is required in the various phases of gastric secretion: in interdigestive period (fasting), in the first phase secretion slozhnoreflektornoy (bazalynaya secretion, due to mechanical stimulation probe) and second, neuro-chemical, phase secretion (Serial, or stimulated, Secretion after applying stimuli).

Feature stimuli gastric glands

As used in clinical and laboratory practice stimuli of the gastric glands of the power of action are divided into three groups:

• weak (enteral);
• submaximal;
• maximum (parenteral).

To the first group belongs stimuli test meal. There are different types of test meal. The most pronounced effect have sokogonnym cabbage broth and broth.

A decoction of the dry cabbage (7 %) prepared as follows:: 21 g dry cabbage pour 500 ml of water and boiled until, until the volume was reduced to 300 ml. Then the broth was filtered through a double layer of cheesecloth and titrated. To this end, 10 ml broth add one or two drops of phenolphthalein and titrate 0,1 and. sodium hydroxide. Cabbage broth titer is expressed in units of conventional microtiter. One unit is equal titrated 1 ml 0,1 and. sodium hydroxide, used for titration 100 ml opens. The titer of cabbage broth should not exceed 20 units (20 mmol). If the titer higher, broth diluted with boiled water.

Bouillon breakfast Zimnitsky: 400 g lean meat boiled 1 l of water on a small fire, until there 400 ml broth with a specific gravity 1,007.

The test meal, as well as the mechanical stimuli are most often used in the study of gastric secretion in outpatient conditions.

The second and third groups of stimuli of the gastric glands (dose dependent) otnosyatsya histamine, gistalog, pentagastrin.

Histamine - Leading a natural stimulant of acid secretion. Interacts with H₂-receptors of parietal cells, activate cell adenylate cyclase and raises cyclic nucleotide adenosine monophosphate (AMF), which causes the synthesis reaction of hydrochloric acid. The effect of histamine depends on the number of parietal cells.

The maximum dose of histamine (0,024 mg / kg of histamine dihydrochloride or 0,055 mg / kg histamine phosphate) It causes secretion 100 % parietal cells - maksimalynыy gistaminovыy test Keya. It gives an indication of the mass of parietal cells at the maximum amount of hydrochloric acid production rate (MAO). Hydrochloric acid is released only parietal cells in a constant concentration. It is estimated, what 1*10¹² cells secrete 23 mmol / h of hydrochloric acid.

Thus, count selection hydrochloric acid can determine the number of parietal cells (men are about 1,09*10¹², in women 0,82*10¹²). Histamine stimulates the release of not only hydrochloric acid, and pepsinogen, glycosaminoglycans, It increases blood circulation in the gastric mucosa, increases the permeability of the vascular wall. Besides, histamine interacts with H₁-receptor cells of various tissues and organs and causes dilation of capillaries, lowering blood pressure, taxikardiju, dizziness, muscle spasm neischerchennyh, including bronchial muscles. Therefore, when using maximum doses of histamine required to conduct antihistamine prophylaxis: intramuscular 2 ml 2 % suprastin or other antihistamines.

Contraindications to the use of maximum dose of histamine: expressed atherosclerosis, myocardial infarction, acute ischemic stroke, pheochromocytoma, arterial hypertension, previous studies (for up to two weeks) gastrorrhagia, pregnancy, allergic diseases.

In elderly and senile age-related changes of gastric mucosa and neurohormonal mechanisms regulating gastric secretion can be used submaximal histamine test only in the preliminary intramuscular injection (for 30 min before histamine injection) 2 ml dimedrol. Besides, for 12 h to study elderly patients need oral dimedrol. In the elderly it is advisable to use as a stimulus of the gastric glands of pentagastrin.

Maximum stimuli - gistalog (1,7-2 Mg / kg s.c.), gastrin II (2 mg / kg s.c.), pentagastrin (6 mg / kg s.c., or 1,2 mg / kg when administered intravenously) - Less toxic, chyem histamine.

A side effect of the introduction of pentagastrin can be duodenalnыy hastralnыy reflux (found in 30 % cases) and the reduction of acidity by neutralizing hydrochloric acid hydrocarbon-bile, gut and pancreatic juice.

Contraindications for use are pentagastrin pregnancy, dumping syndrome with symptoms of hyper- and hypoglycemia, diabetes, hypothalamic syndrome (vegetative-form sosudistaya), chronic pancreatitis, postgastrorezektsionnye disorders, postholepistoektomichesky syndrome.

Combined synthetic drug gistalog by potency equal to histamine. but it does not cause side effects, Therefore, when it is not necessary to use the additional administration of antihistamines.

Thus, the most effective method of maximum stimulation of gastric secretion is intramuscular injection of pentagastrin in the amount of 6 mg / kg body weight. If you do not use it to the maximum dose of histamine. These stimuli can detect hyperplasia and hypersecretion of parietal cells of the gastric glands in hypertrophic gastritis, disease Menetries, duodenal ulcer, Zollinger-Ellison syndrome, as well as the state and the true giposekretornye Achlorhydria.

In the presence of contraindications to the use of maximum histamine test after Kay's study used a simple basal secretion of histamine test (the introduction of a submaximal dose of histamine) .

Where, when to use pentagastrin and histamine are contraindicated, can be used as a stimulus gastric glands eufillina. By virtue of eufillin equates to a submaximal dose of histamine. It increases the level of adenosine monophosphate (AMF), which occur under the influence of the synthesis reaction of hydrochloric acid by the parietal cells of the gastric glands.

The methodology of the study of fractional secretion of stomach

Feasibility study carried out in a special room in a relaxed atmosphere. The patient in the sitting position is administered on an empty stomach for the back of the throat a thin gastric tube, offering easy to swallow and breathe deep the air. In addition, for ease of swallowing probe several patient should tilt your head forward. If the gag reflex increased, probe is inserted through the nose or after preliminary anesthesia of the tongue and throat. Important, to the time from insertion of the probe to retrieve portions of fasting did not exceed 5 m (the duration of the latent period of excitation of the gastric glands).

Gastric contents, retrieved at a later time, It describes the reaction of his glands to mechanical stimulation, instead interdigestive secretion of gastric juice. For complete extraction of gastric end of the probe must be located at a distance of 0,55-0,65 m from the edge of the teeth. Some researchers recommend to introduce the probe to a depth of, equal human growth minus 1 m. To prevent the ingestion of saliva to spit patient offer it in the tray.

When fractional study of gastric secretion fasting gastric juice was prepared, during the first (basal) and second (stimulated) phase secretion. In the case of enteral stimulus important condition is to obtain pure gastric juice without impurities test meal. For this purpose through 25 minutes after gavage of test meal aspirated stomach contents in the future continue to suck clean stimulated gastric juice.

Secretion of fasting

For portions fasting gastric juice no later than 5 minutes from the time of ingestion of the probe all aspirated stomach contents. The study of the quantity and composition of this portion gives an indication of the functional status of the gastric glands in the period interdigestive. A portion of gastric contents, received an empty stomach, subjected to microscopic examination to identify the elements of stagnation and the epithelium of the gastric mucosa.

Bazalynaya secretion

To determine the basal secretion (due to mechanical stimulation probe) after receiving portion on an empty stomach is continuously aspirated gastric juice syringe for 1 no (collected four 15-minute portion).Suction of gastric contents must be regular and as complete as possible.

Stimulirovannaya secretion

Sensing Technique using weak stimuli

After removal of gastric contents into the basal secretion phase the patient is administered by gavage warm test meal (eg, 300 ml of freshly dried cabbage broth) and by 25 All mines aspirated stomach contents, the scope of which is the residue of Leporskaya test meal. Then for 1 h collected four successive portions of gastric secretion. It is pure gastric juice without impurities test meal.

This method is not without flaws. Chief among them - the effect on the secretory function of the stomach is difficult factors considered, as a reaction to the situation of the patient and the process of sensing, his neuro-psychological features, etc.. d. As a result, there is often a deceleration of gastric secretion, therefore, information on low acidity reliable enough. To identify ahilii desirable to use the maximum stimulus of the gastric glands.

Methods soundings using submaximal and maximal stimulus

Use simple histamine test and maximal stimulation of histamine. Noteworthy method Lumbly, wherein administering a submaximal dose of histamine it is combined with the study of basal secretion. Basal secretion, stimulated by histamine, it is advisable to explore for 1 h for comparing the data.

Sensing Technique using submaximal stimuli similar sensing technique with weak stimuli. While obtaining basal secretion by 45 minutes sensing patients, suffering from immune diseases, or older persons 60 years intramuscularly 1 ml 1 % Demerol or solution 2 ml 2 % solution suprastin. After the first hour of the study the basal secretion (Four 15 minute portions) administered subcutaneously histamine dihydrochloride (0,008 mg / kg) or histamine phosphate (0,01 mg / kg). Secretory action of histamine begins to emerge after only 7 10 min after administration, reaching a maximum in 20-30 minutes and lasts for 1-1.5 hours. Gastric contents continue to take over the 1 or 1,5 no (in the absence of free hydrochloric acid). Get a dose on an empty stomach, basal secretion four portions and four or six servings after injection of submaximal doses of histamine.

In seriously ill patients with severe gag reflex to reduce research time sensing can be carried out by A. A. Fisher: basal secretion examined for 30 m, consistent - for 1 no (serving on an empty stomach, two portions of the basal secretion, four servings of sequential secretion). Usually expressed for secretion 1 no, so the performance of 30-minute basal secretion should redouble.

Comparison of basal and submaximal acidity to determine the mechanism of disorders of gastric secretion.

Maksimalynыy gistaminovыy test Keya

After removing portions of fasting and two 15 minute basal secretion portions intramuscularly 2 ml 2 % solution or suprastin 1 ml 1 % dimedrol solution and continue to continuous suctioning, getting two servings of basal secretion. Then, the maximum dose administered subcutaneously histamine and aspirated gastric juice for 1-2 hours. Get a dose on an empty stomach, four servings of basal secretion, four or eight portions maximal stimulation.

Introduction antihistamine prevents the toxic effects of maximum doses of histamine. In some cases,, despite antihistamine prophylaxis, when the maximum histamine test Kay patients may experience fainting or severe dizziness, a sharp decline in blood pressure, general weakness. In the event of such phenomena, due to the introduction of histamine, sensing stop, the probe is removed, impose on a limb tourniquet above the injection site for 15-20 minutes and injected epinephrine hydrochloride (1 ml 0,1 % solution subcutaneously) and antihistamines. Application of maximum histamine test Kay is not recommended in debilitated patients and elderly.

Maximum stimulation of histamine activates the parietal cells, there is a direct relationship between the amount of hydrochloric acid and isolation of the parietal cell mass.

Pentagastrinovy ​​test

For maximum stimulation of gastric glands used pentagastrin. When administered subcutaneously in an amount 6 mg / kg, it stimulates the secretion of gastric glands more intensively, chyem histamine. Pentagastrin can be used on an outpatient basis.

Secretory action of pentagastrin manifested through 10 minutes and reaches its maximum after 20-30 min after administration. Pentagastrin stimulates the secretion of hydrochloric acid and biermerin.

Pentagastrinovy ​​test was carried out as follows. After removing portions of fasting for 1 collected four hour 15 minute basal secretion portions and administered intramuscularly at the rate of pentagastrin 6 mg / kg, then for 1 h continue to collect the gastric juice.

Eufillinovy ​​test

In the presence of contraindications to the use of histamine can be used aminophylline, which is equal to the force of action submaximal stimuli.

Eufillinovy ​​test was carried out as follows. After receiving portions fasting and basal secretion over 1 h the patient is administered through a tube at the rate of aminophylline 30 mg / kg body weight, diluted in 300 ml warm distilled water. Through 25 min aspirated residue and measuring its volume. Subsequently produce continuous suctioning the gastric juice within one or two hours (just get 9 or 13 Servings). With the introduction of eufillina side effects sometimes occur - a short-term dizziness, low blood pressure, tachycardia, that quickly pass. Contraindications to the use of the same eufillina, as for the probe method of investigation.

When you select a probe method study of gastric secretion should be based on the objective conditions and sensing. During the initial examination of the patient in the outpatient setting is recommended fractional study with enteric stimuli. Only in the absence of such a possibility is allowed a one-time recovery of gastric contents thick probe. In therapeutic offices general advisable to use the method of submaximal stimulation. To differentiate Achlorhydria pentagastrinovy ​​method applied or the maximum histamine test Kay. When the fractional test of gastric secretory function should be possible to complete aspiration of gastric juice, as defined by its full amount: interdigestive (serving on an empty stomach), basal and consistent (Stimulated) secretion.

Determination of gastric fullness suction

To account for the completeness of aspiration of gastric juice is carried out fractional sounding two-channel gastroduodenal probe, one channel is used for aspiration of gastric juice, another for drip markera- 10 % PEG solution (PEG), having a molecular weight 4000, at a rate of 15 20 drops 1 m. PEG is not absorbed in the stomach and does not react with the components of the gastric juice. As the difference between the insertion and extraction of 1 h determine the extent of the amount of PEG gastric suction Percentage.

Determination of gastric fullness suction reveals a group of patients with gastric secretory deficiency false, and hence, eliminate unnecessary and harmful, and stimulating substitution therapy of gastric secretory function. With increased gastric secretion application of this method makes it possible to identify the degree of acidity and choose the adequate antacid and other therapies.