Observations on the Function of the Pylorus as Revealed by Duodenal Regurgitation.

Abstract

The recent attention given to Boldyreff's theory 1 , 2 , 3 of the automatic regulation of the acidity of the stomach through duodenal regurgitation, has opened up an important line of clinical investigation. Two methods of determining regurgitation are being employed, the presence of bile in the stomach, and the estimation of the total chlorides of the stomach content as compared with the free or total acid.

We have investigated the presence of trypsin and bile in the fasting stomach, as well as their disappearance and reappearance in the stomach in the presence of water and dilute acid and alkali.

Nine examinations were made on cases as follows:

5 total achylia, giving no acid on fractional meals or after injection of histamine (pernicious anemia).

1 normal.

1 low duodenal obstruction from retroperitoneal growth.

1 duodenal ulcer.

1 pyloric resection by the Polya method.

In carrying out the experiments, the contents of the fasting stomach were removed through a Rehfuss tube with the olive located in the lower part of the stomach. The stomach was then washed at 3 to 5 minute intervals with small amounts of water or of the reagent selected, and samples immediately withdrawn; or the reagent was allowed to remain in the stomach and portions fractioned out at 5 to 10 minute intervals.

In testing for the presence of trypsin, the stomach content was centrifuged or filtered if opaque, the clear fluid was then shaken with permutit to remove ammonia and a solution of purified egg albumin added to each. The mixture was then brought to a pH of 8.5 (just alkaline to phenolphthalein) and allowed to incubate 48 hours at 37°, when amino acids were tested for by Folin's method.