Kwiecień S, Konturek S J
Department of Physiology, Jagiellonian University Medical College, Cracow, Poland.
J Physiol Pharmacol. 2003 Dec;54 Suppl 3:69-82.
For centuries it was recognized that the stomach produces a juice, which has acidic properties, however, it was not until 1824 when Prout demonstrated the presence of hydrochloric acid in gastric juice. At the same time experiments on a patient with gastric fistula began by W. Beaumont showing alterations of acid secretion after meals and under various psychological conditions. After the discovery by L. Popielski in 1920 that histamine is a direct stimulant of oxyntic glands, histamine started to be used in the 1930s in gastric secretory tests. Then in 1949 the dose of histamine was established by K. Kowalewski to induce in humans maximal gastric secretion and in 1953 Kay from UK, using a similar dose of histamine (0.04 mg/kg), introduced augmented histamine test to determine maximal acid output. The digestive period of gastric secretion can be divided into 3 phases: cephalic phase, gastric phase, and intestinal phase. When an acidified meal reaches the antrum or proximal part of the small intestine, the inhibitory autoregulatory mechanisms are triggered. Using a peptone meal as a physiological stimulant of gastric secretion, Fordtran and Walsh designed in 1973 the intragastric titration method. Histamine stimulates H1 and H2 receptors, producing some side effects so Betazole (Histalog), an analogue of histamine was introduced, because of smaller side effects than with histamine. In 1967, pentagastrin, which contains a C-terminal amino-acid sequence of gastrin and does not exert serious side effects, was applied first in Poland as a stimulant of gastric acid secretion instead of histamine. At the present time, a 12 or 24 h pH-metry with a magnetic recording of gastric acidity using the Digitrapper was found to have a greater diagnostic value in assessment of gastric acid secretion under natural conditions including meal than classic gastric secretory tests. This technique has been widely used in detecting the duodeno-gastric or gastro-esophageal reflux (GERD) and testing various drugs affecting gastric acid secretion and healing acid-pepsin disorders.
几个世纪以来，人们就认识到胃会分泌一种具有酸性的汁液，然而，直到1824年普劳特证明胃液中存在盐酸。与此同时，W. 博蒙特开始对一名胃瘘患者进行实验，结果显示进食后以及在各种心理状态下胃酸分泌会发生变化。1920年L. 波皮耶尔斯基发现组胺是壁细胞腺的直接刺激物后，20世纪30年代组胺开始用于胃液分泌测试。1949年，K. 科瓦列夫斯基确定了能诱导人体最大胃酸分泌的组胺剂量，1953年，英国的凯使用类似剂量的组胺（0.04毫克/千克）引入了增强组胺试验以测定最大胃酸排出量。胃液分泌的消化期可分为三个阶段：头期、胃期和肠期。当酸化食物到达胃窦或小肠近端时，抑制性自动调节机制就会被触发。1973年，福特兰和沃尔什以蛋白胨餐作为胃液分泌的生理刺激物，设计了胃内滴定法。组胺会刺激H1和H2受体，产生一些副作用，因此引入了组胺类似物倍他唑（组胺甲硫醇），因为其副作用比组胺小。1967年，含有胃泌素C端氨基酸序列且无严重副作用的五肽胃泌素首次在波兰作为胃酸分泌刺激物替代组胺使用。目前，使用数字记录仪进行12或24小时胃酸度磁记录的pH测量法，在评估包括进食在内的自然条件下的胃酸分泌方面，比传统的胃液分泌测试具有更大的诊断价值。这项技术已广泛用于检测十二指肠 - 胃或胃 - 食管反流（GERD）以及测试各种影响胃酸分泌和治疗酸 - 胃蛋白酶紊乱的药物。
