Rôle of Decreased Amount of Gastric Secretion in Production of Pernicious Anemia

Abstract

In addition to the failure to secrete hydrochloric acid, patients with pernicious anemia secrete very little fluid into their stomachs, either while fasting or after the subcutaneous injection of histamin hydrochloride. The average secretion in 32 collections from 5 patients with true pernicious anemia was 20 cc. per hour, as compared with an average of about 150 cc. per hour for normal individuals. To note the part played by the diminished amount of secretion, as opposed to a qualitative difference from normal, gastric juice from 5 untreated patients with pernicious anemia in relapse (red blood cell counts varying from 1.5 to 3.3 millions per cu. mm.) was collected during a period of 8 weeks and stored in a refrigerator until 1500 cc. had been collected. A daily dose of 150 gm. of gastric juice was incubated with 200 gm. of meat for 2 hours, at a pH of 2.0 and later made pH 5. This was fed for 10 days to a patient with typical pernicious anemia, whose initial red blood cell count was 1.93 million, white blood cells 4200 per cu. mm., hemoglobin 51% (Sahli) 7.14 gm. %. The chart shows that a rise in the percentage of reticulocytes started on the tenth day, and reached a maximum of 9.8% on the thirteenth day. This was accompanied by an increase in the number of red blood cells and in the hemoglobin percentage. From the 10th to the 19th day no further treatment was given and the reticulocyte percentage fell to the pre-treatment level. Starting on the 20th day, a daily dose of 10 gm. of a concentrated dried extract of gastric tissue was fed with a subsequent reticulocyte response with a maximum of 17%. The experiment suggests that if pernicious anemia gastric juice, in quantities similar to that secreted by a normal person, is fed (after incubation with beef steak) hematopoietic activity develops. The experiment is now being repeated with various modifications to verify the conclusions.