Indirect gastric secretory studies; a comparison of tubeless gastric analysis and plasma pepsinogen determination as screening procedures.

The results of the two simple gastric secretory tests, tubeless gastric analysis and plasma pepsinogen determination, were determined in 217 patients without gastrointestinal disease or azotemia. Patients with pernicious anemia, gastric cancer, duodenal ulcer, azotemia, and diabetes mellitus undergoing depot insulin therapy were also studied. Low pepinsogen in the blood tended to occur with anacidity, while a significantly higher mean pepsinogen level was noted with acid-secreting ability. Similarly, low pepsinogen values were found in the presence of pernicious anemia and gastric cancer, while elevated results were noted with duodenal ulcer, although individual exceptions occurred in most conditions. When positive, tubeless gastric analysis results were shown to be reliable qualitative evidence of ability to secrete acid. A negative resin finding was noted to be strongly suggestive evidence of anacidity or hypochlorhydria, whereas the likelihood that true achlorhydria existed was markedly increased if a second tubeless gastric analysis result was also negative. The two indirect tests of gastric secretory function were shown to complement each other. The effects of various diseases and therapy on gastric pepsin production and plasma pepsinogen values have been discussed. It is felt that these two procedures will find considerable application as screening tests for conditions with altered gastric secretory function, because of their simplicity and accuracy.