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KMID : 0378019590020120085
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New Medical Journal
1959 Volume.2 No. 12 p.85 ~ p.93
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Clinical Studies on the Neutral Red Excretion into the Stomach
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Abstract
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Summary
To our knowledge, some injected dye, particularly neutral red which is commonly used, disregarded by the achylic stomach Sontrary to the abundant appearance of the dye in acid stomach and this fact appreciated some differential diagnostic value.
As for the mechanism of nutral red transfer, there is still controversy, whether it is a simple physicochemical process, i.e. concentration gradient between blood and gastric juice or specific glandular activity is also: involved.
I have investigated the behavior of neutral red excretion *in bile as well as in s´romach under various conditions.
Material and Method
150 cases, mostly gastroenterological patients, comprised of 90 men and 60 women and age of ranging from 14 to 69, were examined by Katch-Kalk method combined with fractional aspiration over 2hour period. 4m1. of 1% aqueous solution of neutral, red was injected ´intramuscularly immediately after the administration of test meal. Onset of dye appearance, its concentration., duration, free and total acidity, pepsin and total chloride were estimated on each fraction. Basal secretion was also checked. Achlorhydria cases were re-examined by histamine test. In 7 cases the secretion of the dye in bile also examined in detail. In some cases effect of HCl instillation into stomach upon the gastric secretion of the injected dye also observed. Some interesting results were obtained and the tmnsfering mechanism of thy dye was discussed.
Results
The dye made its appearance in gastric secretion in all cases except achlorhydria and 2 hyperacid cases. The onset of excretion was 10^102 minutes, the average being 27.4 min. Close relationship was
shown between average total or free acidity and onset of excretion, so the more the acidity high, the more the onset rapid. Amount of basal secretion and aver-age pepsin concentration also show edthe same tendency, though it was much less clear-cut. Most of 14 cases failed to excrete the dye were of achlorhydria. But 2 hyperacid stomach, gastric carcinoma and peptic ulcer each, excreted no dye claiming significance i for the mechanism of neutral red transfer.
Malignancies of stomach, 9 carcinoma and 1 aarcoma, slap refused to excrete the dye or did in trace only. Average onset of excretion in various gastroenterologicai conditions lined up as follows peptic ulcer, intestinal parasites, gastric neurosis, hepato-biliary diseases, chronic gastritis, anacidity syndrome and gastric malignancies from the fastest to the slowest.
No significant difference was seen between the on-set of excretion into.the bile and into the gastric. juice. Few cases excreted the dye neither in bile nor in stomach. Duration of gastric excretion outlast that of bile being more than 3^-4 hours vs. 2h.
In histamine-proved achlorhydria, 300m]. of N/IO HCI, placed in the stomach, showed no dye against the observation of V.Vallo & T. Javor who have seen the dye in the instilled acid solution into the gastric pouch or isolated Thiry Vella loop of animals.
The author holds that the dye concentration gradient between blood and gastric juice is the dominant factor for the mechanism of neutral red transfer. Secretion of endogenous HCl is assumed to be a kind of vehicle by which the dye excreted into stomach. But hyperacid cases, failed to show dye suggest another factor, possibly specific glandular activity is also operating. The possibility of false excretion simulated by regurgitating duodenal fluid into stomach is negligible.
These facts in mind, the neutral red injection method, i if combined with conventional gastric analysis such as Katch-Kalk method, will add more diagnostic value
to the latter which is less informative than maximal, histamine test but still in use because of its simple procedure.
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