Fordtran J S, Walsh J H
J Clin Invest. 1973 Mar;52(3):645-57. doi: 10.1172/JCI107226.
New methods are described by which the buffer content and the rate and pattern of net gastric acid secretion in human subjects fed normal meals can be measured by use of sodium bicarbonate infusion to control intragastric pH. With these techniques, it was shown that the rate of acid secretion in response to a steak meal in seven duodenal ulcer patients was twice the rate achieved in six control subjects and that the amount of acid secreted after eating exceeded the peak histamine response in the ulcer patients but not in the controls. Meal-stimulated acid secretion, expressed as a function of the peak histamine response, was roughly correlated with the serum gastrin concentration (r = 0.45), but it was concluded that other factors must also contribute to the higher than normal secretory responses to a meal found in duodenal ulcer patients. Measurement of buffer content of the stomach revealed that the duodenal ulcer patients emptied the meal buffer at a much more rapid rate than the normal subjects. By 2 h after eating, the ulcer subjects had less than half as much buffer in their stomachs as the controls. The combination of acid hypersecretion and rapid buffer emptying leads to abnormally high gastric acidity after a meal in duodenal ulcer patients. These results suggest that, in addition to a large parietal cell mass, parietal cell responsiveness to a meal and the rate of buffer emptying may be important in the pathogenesis of duodenal ulcer.
本文描述了一些新方法，通过输注碳酸氢钠来控制胃内pH值，从而测定正常饮食的人体受试者的缓冲液含量以及胃酸净分泌的速率和模式。运用这些技术发现，7名十二指肠溃疡患者对牛排餐的胃酸分泌速率是6名对照受试者的两倍，而且溃疡患者进食后分泌的酸量超过了组胺刺激后的峰值，但对照受试者未出现这种情况。以组胺刺激后的峰值为函数表示的餐食刺激胃酸分泌，与血清胃泌素浓度大致相关（r = 0.45），但得出的结论是，十二指肠溃疡患者对餐食的分泌反应高于正常水平，必定还有其他因素在起作用。对胃缓冲液含量的测量显示，十二指肠溃疡患者排空餐食缓冲液的速度比正常受试者快得多。进食后2小时，溃疡患者胃内的缓冲液量不到对照受试者的一半。胃酸分泌过多和缓冲液快速排空相结合，导致十二指肠溃疡患者进食后胃酸度异常升高。这些结果表明，除了壁细胞数量众多外，壁细胞对餐食的反应性以及缓冲液排空速率在十二指肠溃疡的发病机制中可能也很重要。
