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Gastric Analysis

By Walter W. Chan, MD, MPH, Assistant Professor of Medicine;Director, Center for Gastrointestinal Motility, Division of Gastroenterology, Hepatology, and Endoscopy, Harvard Medical School;Brigham and Women's Hospital

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Gastric acid analysis is rarely done in current practice. When conducted, samples of stomach contents obtained via NGT are used to measure gastric acid output in a basal and stimulated state. This information may be useful in a patient who develops a recurrent ulcer after surgical vagotomy for peptic ulcer disease. In this case, a positive acid response to stimulation (sham feeding) indicates an incomplete vagotomy.

The test also is used to evaluate a patient with elevated serum gastrin levels. Hyperchlorhydria in the presence of elevated gastrin usually indicates Zollinger-Ellison syndrome. Hypochlorhydria in the presence of elevated gastrin indicates impairment of acid output, such as occurs in pernicious anemia, atrophic gastritis, and Ménétrier disease and after inhibition of gastric acid secretion by potent antisecretory drugs.

To do gastric analysis, an NGT is inserted and the gastric contents are aspirated and discarded. Gastric juice is then collected for 1 h, divided into four 15-min samples. These samples represent basal acid output.

Gastric analysis can also be done during catheter-based esophageal pH-monitoring. Complications are very rare.