Stomach Physiology

2.1 Introductive notions

The stomach is a hollow organ, located between the esophagus and
duodenum. Has a vertical portion, consisting of the body and bottom of the stomach,
and is considered to be the acid stomach, as glands secrete HCl and pepsinogen
here in large quantities. Motor function of this portion is reduced, especially with the
storage role. Horizontal portion (pyloric antrum and pyloric canal) is considered to be
the alkaline stomach, as this glands here releasing mucus and gastrin in large
quantities. Motor activity at this level is characterized by mixing movements and
propelling food.
The stomach has three major functions:

Secretory, glandular stomach mucosa contains cells that synthesize

and secrete organic substances (enzymes, mucus, intrinsic factor
Castle) and inorganic (hydrochloric acid, water, electrolytes). Gastric
juice is a mixture of the product of secretion of gastric glands and
epithelial cells of gastric mucosa.
Motor function, which consists of mixed solid food with gastric juice
and intermittent elimination of duodenal gastric mixture
Endocrine, in which glands from antro-pyloric mucosa, as well as
glands from duodenal mucosa, synthetize regulatory peptides, used as
local hormones: gastrine, somatostatine, VIP, bombesine.

2.1.1 Physical and chemical properties of gastric juice

Aspect and colour: colorless liquid, slightly opalescent, rarely with pearl gray
appearance.
Smell: is odorless or has a sour smell pungent.
Taste: sour, due to acidity.
pH: 1 - 2.5 per adult, in infants being less acid (4.5).
Density: 1,002 1,009 g/cm3
Freezing point: starting from -1,550C to 0,600C
Secretion volume/24h: 2 2,5 litres
Gastric juice contains:
Water 99%
Dry residue 1% of which:
0,6% are inorganic substances
0,4% are organic substances
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The most important substances found in gastric juice are presented in Table
2.1.

WHERE IS
SECRETED

SUBSTANCE

ROLE

Hydrochloric Acid

-solubilises
proteins,
forming
acidalbuminele, preparing them for
digestion

(HCl)

- oxintice or parietal
cells, gastric marginal
glands, located mostly
in stomach acid.

- gives optimum pH for the action of

gastric enzymes;
-bactericid action
-promotes transformation in Fe3 in Fe2
+ absorbable
-proteolytic enzyme
-hydrolysed proteins solubilized in
advance by hydrochloric acid, turning
them into smaller peptides
- in adult, in the absence
labfermentului, milk protein digestionis
made.

- peptic cells, of
gastric glands, under
inactive form of
pepsinogen.

Labferment

- proteolytic enzyme
- gastric secretion-only present in infant
-in the presence of Ca ions, Ca casein
turns into paracazeinat

-peptic cells, chief cells

of gasric glands.

- proteolytic enzyme
-liquefying action on several
proteoglycans, especially gelatin.

-principle
cells
gastric glands

of

Gelatinase

- lipolytic enzyme
- soft hydrolyzes emulsified fat-milk,
cream, mayonnaise.

-principle
cells
gastric glands

of

Lipase

- surface mucous cells,

especially at the pyloric
glands level.

Mucus

- mixture of glycoproteins called mucin

water
-mechanical and chemical protection of
the gastric mucosa.
- alkaline-forming a gel that has gastric
epithelial surface, providing protection
against mucosal digestion by pepsin
and HCl.
- HCO3-with alkaline-forming barrier,
protecting the gastric mucosa
-lubricate food.
-promotes absorption of vitamin B12
(cyanocobalamin)
-forms a complex with the vitamin,
which is absorbed in the small intestine
-when intrinsic factor is absent or in
short supply, there is vitamin
deficiency. B12 causes megaloblastic
anemia Biermer, also called pernicious
anemia.

oxintic-cells,
parietal
gastric mucosa, with
HCl.

-hormone, the main physiological

stimulus for secretion of HCl and
pepsinogen (gastric phase of gastric
secretion)

G-cells of:
antro-pyloric mucosa
duodenal mucosa
pancreatic islets (fetal
life)
certain parts of the
nervous system
(hypothalamus)
In pathology, the
pancreatic tumors,
gastric or duodenal
secreting gastrin

Pepsine

Intrinsec Factor

-other actions:
Gastrine

Somatostatine

trophic role: stimulates growth of

gastric and small bowel mucosa
stimulates gastric motility
stimulates the secretion of
histamine
from
cells
enterocromafine-like
stimulate insulin secretion, but
only after a protein lunch
- hormone that inhibits the release of
gastrin from G cells, but also other
hormones involved in regulating
3 cholecystokinin,
digestion, as secretin,
VIP, GIP, enteroglucagone
- directly
enzymes

inhibits

cells
and

secreting
HCl

Table nr 2.1

-hypothalamus;
-endocrine cells of the
stomach
and
duodenum.

2.1.2 Harvesting gastric juice

Gastric tubing technique

It consists in extracting gastric juice in the morning on an empty stomach (
jeun) using an Einhorn probe (flexible tube) inserted into the stomach. First
harvest gastric juice accumulated during the night (basal) and then the gastric
juice produced after stimulated secretion of secretagogues substances
administered injectable (parenteral) or by probe.
As secretagogues substances use:
injectable histamine, which stimulates gastric secretion by
stimulating H2;
pentagastrine, which has a stimulating effect on gastric
secretion, by rising the gastrine releasing level;
insulin, induces hypoglycemia, which on a vagal way, through
both hypothalamic and gastrosecreting center stimulates the
release of gastrin;
administered by probe: alcohol, caffeine acts directly on the
mucosa.
Currently this technique is less used, being replaced by gastric
endoscopy exploration technique. This, in addition to viewing the esophageal
mucosa, gastric mucosa and the early part of duodenum, allows harvesting
the gastric juice through aspiration, as well as harvesting gastric tissue used
for a histopathological examination.
Is achieved with a gastrofibroscop, equipped with a thin, flexible tube
fitted with optics insufflation and suction system. Images are taken from a
video camera that transmits to a TV screen.
Of gastric juice so collected or obtained by gastric lavage, in the
laboratory, investigations may be carried, either biochemical, cytological and
bacteriological. It can reveal tumor cells, bacteria (Helicobacter pylori),
epithelial cells or parasites.
Gastric secretion may be obtained also by doing a gastric lavage
performed by aspirating the stomach contents, in case of intentional or
accidental ingestion of toxic substances: poisons, drugs, too much alcohol in
children. Through a Fauchet gastric tube aspirate the gastric content, after
which, place water using the probe, and then aspirate.

Gastric juice experimental harvesting

Functioning of the stomach and other parts of the digestive tract was
cleared using animals, especially dogs, imagining the different experimental
models that helped to describe phases of gastric secretion.
The most famous example is the "little stomach" of IP Pavlov, which
was obtained by the gastric secretion through nervous, vagal and humoral
way.

Still
Pavlov has
done
the
experiment
called
"fictional
lunch"
showing
the cephalic
phase
(nervous
mechanism)
of
gastric
secretion, the role of vague nerves and gastric conditioning in gastric
secretion.
Figure2.2.
Experiment "fictional Lunch" by I. P. Pavlov. Gastric fistula combined with esofagostomy.
Oe - sectionated esophagus and opened outside (esofagotomy and esofagostomy) for harvesting
ingested food (food does not reach the stomach).
S Stomach with Basov chronic gastric fistula;
C - gastric cannula through which flows gastric juice secreted during fictional lunch.

Other models require separated, isolated portions of the stomach,

creating some types of "bags" that can keep vagal innervation for highlighting
both mechanisms of gastric secretion (nervous and humoral) or may be
denervated, in this case for studying only humoral mechanism.

Figure 2.3
"small
stomach"
Pavlov, also called
or "vagal nerves
obtaining
gastric
the nervous and
mechanism (vagal).

Model
imagined
I.P.
"Pavlov's purse"
bag."
Allows
juice produced by
humoral

Its
been proved
the existence of cephalic phase of gastric secretion, started by food contact
with oral cavity receptors (unconditioned reflex), but also at sight or smell of
food (conditioned reflex).
2.2. PRACTICAL ACTIVITY
2.2.1. Dosage of hydrochloric acid in gastric juice
Principle:
Gastric acidity is neutralized with sodium hydroxide solution 0.1 N in the
presence of Tpffer-Linossier reagent (a mixture of Tpffer indicator and
phenolphthalein, which has a yellow orange color).
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Free HCl colors the reagent red, when the pH of the solution is lower than 2.9,
at pH 3, the reagent becomes orange and the color turns yellow at pH 4, indicating
that the free HCl has been neutralized. In the presence of phenolphthalein, at pH 7,
the solution is colorless and turns red-violet at pH 9 -10 (indicating that bound HCl
has been neutralized).
Necessary Materials:
Pipettes
Erlenmeyer flask
Burette
Gastric juice
0.1 N NaOH
Tpffer-Linossier reagent
Technique:
In an Erlenmeyer flask 10 cm3 gastric juice and 3-4 drops of reagent
Tpffer-Linossier are added.
In the presence of Tpffer-Linossier reagent, gastric juice turns red due to the
presence of HCl, indicating a pH lower than 2.9.
By titrating with 0.1 N NaOH solution until the color changes to orange and
then to yellow. At this point, the titration process is stopped and the number of
milliliters of NaOH needed for the titration of free HCL is labeled N 1.
The titration continues until a red-violet color appears (at pH 9-10), indicating
that the total amount of acid has been neutralized including the bound HCl (in an
intermediate stage the solution turns yellow). The number of milliliters of 0.1 N
NaOH solution needed for the titration of total acidity is labeled N 2.
The number milliliters of NaOH solution used to neutralize bound HCl = N2 N1.
Results:
The results are expressed in grams of hydrochloric acid in 1000 cm 3 of gastric
juice or in mEq / L.
In order to express the results in grams of HCl in 1000 cm 3 of gastric juice, we
multiply the following: the number of cm 3 NaOH 0.1 N consumed; the equivalent
weight of one cm3 of HCl 0.1 N solution (0.00365 g) and 100.
In order to express the results in mEq / L:
Concentration of NaOH solution used in titration is 0.1 N. Knowing that a 1N
NaOH solution has a concentration of 1 gram Eq / L NaOH, we can determine that
the NaOH solution used (0.1 N) has a concentration of 0.1 Eq gram /L or 100 mEq /
L.

Calculation example:
CNaOH x VNaOH = CHCl x VHCl
CNaOH = 100 mEq grams/ L (concentration of NaOH solution used in titration)
VNaOH = N (number of ml of NaOH used in titration)
CHCl = concentration of HCl in gastric juice - unknown
VHCl = 10 mL (number of mL of gastric juice used)
Substituting with numeric values in the example, we obtain the following equation:
CHCl = N x 10 mEq gram/L
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HCl
Free HCl
Total HCl
Bound
HCl

g/1000 ml gastric juice

N1 x 0,00365 x 100
N2 x 0,00365 x 100
(N2 - N1) x 0,00365 x 100

mEq/L
N1 x 10 mEq gram/L.
N2 x 10 mEq gram/L.
(N2 - N1) x 10 mEq
gram/L.

Table no. 2.2. Formulas for

calculating the values of gastric
acidity

Normal values:
The proper way to express the acidity of gastric juice is through hourly basal
rate of HCl secretion, which is the amount of hydrochloric acid secreted by the
stomach in an hour, in basal conditions (without stimulating secretion), with a value
of 1.5 - 2.5 mEq/L.

Normal values of acidity without stimulation:

Measurem
ent Units

g /1000
mL

mEq/L

Free HCl

0,3 - 1,5

10 - 40

Total HCl

0,7 - 3

20 - 60
Tabel no. 2.3.

Normal values of acidity after stimulation with histamine:

Measurem
ent Units

g /1000
mL

mEq/L

Free HCl

1,7-3

50-130

Total HCl

2-4

60-150
Table no. 2.4.

2.2.2 Highlighting free hydrochloric acid in gastric juice

Principle:
Gnsburg reagent in the presence of free hydrochloric acid by heating and
evaporation gives a carmine-red color. Purpose of this paper is to highlight the free
hydrochloric acid in gastric juice, when it can not be dispensed, because it is in very
small quantities. Its presence prooves that the secretory function of the gastric
mucosa is not totally compromised.

Necessary Materials:

Fresh gastric juice (being kept for long time it volatilises)

Gnsburg reagent (vaniline solution and fluoroglicine in alcohol)
Porcelain capsule
Fire source
Technique:
In a porcelain capsule place 2-3 drops of of alcoholic solutions of vanillin and
fluoroglicine. Add 2-3 drops of examined gastric juice. Heat slowly till the content
evaporates.
Results:
The appearance of red-carmin colours indicates the presence of free hydrochloric
acid and that the gastric mucosa secretory potential.
The lack of colour shows that the entire secretory capacity of the gastric mucosa is
compromised.
2.2.3 Highlighting the lactic acid in the gastric juice
In normal conditions, lactic acid is not found in the gastric juice. It results from gastric
fermentation of sugars (glucids) under the influence of bacillus Boas-Oppler, in both
hypo and anacidity conditions, and also in case of a long gastric stasis.
Principle:
Highlighting the lactic acid is based on the property of axiacids of giving colour
reactions with ferric salts.
Neccesary Materials:

Gastric juice
Uffelman reactive (contains ferric chloride and has a blue-purple colour)
Pipettes
Stand

Technique:
Use 2 tubes: witness and probe.

Reactiv Uffelman
Gastric juice
Saline solution

tube 1- witness

tube 2 - probe

5 - 6 ml

5 - 6 ml

1 ml

1 ml

Table nr. 2.5. Substances in tubes

Results:
Tube 1, witness (no lactic acid), doesnt change colour;
Tube 2, probe, turns green-yellow due to the ferum lactate development.
2.2.4. Highlighting pepsins proteolytic activity
Principle:
The pesin of the gastric juice, hydrolises a substrate, more exactly a large quantity of
casein in solution, in a precise time at standard temperature.
Required Materials:

Gastric juice
Saline solution
Casein acid solution 1, heated at 37C
Sodium acetate solution 20%
Tubes, stand
Thermostat (set at 38oC)

Technique:
It uses 2 tubes, witness (without enzyme) and probe.

Caseine acid solution

1
Gastric juice
Saline solution
Thermostat 38C
Sodium
solution20%

acetate

tube 1

tube 2

witness

witness

10 ml

10 ml

1ml

1ml

15 min

15 min

1ml

1ml

Table nr. 2.6. Substanele in reaction tubes

Results:
In presence of sodium acetate, caseine precipitates

Precipitates appearance, in witness tube proves that caseine hasnt been

hydrolised, through lack of enzyme.
In nect tube, the solution is cleared, although pepsine reacted and hydrolised
the caseine.

2.2.5 Milk coagulation by labferment action

Principle:
Milk coagulates, in presence of labferment calcium ions, resulting insoluble calcium
paracazeinat.
This reaction takes place in two phases:
First phase (enzymatic): under labferment action, at a pH of 4,5 5,5 at a
temperature of 37C, milk cazeinogen turns into soluble paracazeine
(cazeogene).
Second phase (chemical): under calcium ions action, paracazeine turns into
insoluble calcium paracazeinate (cazeum = curd).
Required materials:
Labferment solution 1%
Fresh milk
5 tubes, stand
Thermostat set at 37C
potassium oxalate solution 10%
calcium chloride solution 10%
Technique:
Tube

Tube

Tube

Tube

Tube

Fresh milk

5 ml

5 ml

5 ml

5 ml

5 ml

K oxalate solution

1 ml

1 ml

1 ml

Labferment

1 ml

1 ml

1 ml

1 ml

Inactivated
Labferment (boiling)

1 ml

Ca chloride solution

1 ml

Thermostat 37C

30 min

30 min

30 min

30 min

30 min

Boiling

1 minut

Ca Chloride solution

1 ml

Table nr. 2.7. Substances in reaction tubes

Results:

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Tube 1: milk coagulates under action of active labferment

Tube 2: milk doesnt coagulates, because labferment was inactivated through boiling
Tube 3: milk doesnt coagulates, because potassium oxalate links calcium ions,
without which clotting cant occur
Tube 4: milk coagulates, due to the presence of calcium ions, exccesively added to
the potassium oxalate binding capacity.
Tube 5: milk doesnt coagulates after thermostat operation, calcium ions are missing
as they are binded to potassium oxalate. First phase of coagulation took place in the
thermostat. Through later boiling, labferment inactivates, and by adding CaCl 2 milk
will coagulate, in phase tow of clotting. In this tube, the two phases of clotting are
outlined.
2.3 MODIFICATIONS OF GASTRIC SECRETION
Gastric secretion may be incresed, decreased or abolished. Increased hydrochloric
acid over the top of the physiological range, is called hyperclorhidria.
To define increased value of total acidity ther term hyperacidity is used. Since most
gastric acidity is caused by hydrochloric acid, the two terms sometimes overlap. Low
levels of hydrochloric acid under physiological limits represent hypochlorhydria.
To lower total acidity the term used is hypoacidity. Lack of acidity is defined by
anacidity. Association of anacidity with the lack of peptic secretion representes
gastric achillie.
Ulcer disease is an imbalance of mucosal protective factors (mucus and
bicarbonate) and those who can agress the mucosa (HCl and pepsin). Increased
gastric acidity and decrease mucosal protective capacity are the two major
mechanisms involved in the development of gastric and duodenal ulcers.
Gastric mucosal barrier protection, consisting of mucus and bicarbonate, can be
degraded under the action:

pepsinogen and hydrochloric acid in excess. Excess secretion of HCl will be

depressed by the administration of proton pump inhibitors or H2 blockers;
Helicobacter pylori. Involvement of bacteria in the production of gastric ulcers
explain antibiotic treatment with HCl synthesis inhibitors;
by altering the secretion of mucus quantity and quality
by taking aspirin and other NSAIDs indicated for the treatment of pain and
inflammation.

Consulting a medical dictionary or teaching materials, please define the following

terms: esofagotomy, esofagostomy, secretagogues substances, fasting,
megaloblastic, NSAIDs oxintice cells, Achille stomach, parenteral, endopeptidase,
and other terms found in this chapter that you do not know.
2.4 Questions
1. List stocmach parts.
2. How does gastric juice is harvested in a hospital?
3. What are the secretagogues substances used in gastric tubing
mechanisms does it work?
11

and by what

4. What is the pH of gastric juice?

5. Normal hydrochloric acid in gastric juice.
6. List the enzymes in gastric juice and specify their type as the substrate on which
they act.
7. Pepsin: what it is, where is, on who acts and what is the result?
8. In what form is pepsin secreted and how is activated?
9. Labferment: where there is, on who and how does it work?
10. Gastric phases - enumeration.
11. Nervous mechanism of gastric secretion: by whom is represented?
12. Humoral mechanism of gastric secretion: by whom are done?
13. What secretion mechanism predominates in cephalic phase of gastric secretion?
14. What mechanism predominates during gastric secretion of gastric juice
secretion?
15. What mechanism predominates during intestinal secretion of gastric juice
secretion?
16. What is enterogastronul and how does it act?
17. Gastrin: that is, instead of secretion, action.
18. How is it called the increase of gastric juice acidity?
19. How is it called the decrease of gastric juice acidity?
20. What is Achillia?
21. What are enzymes secreted by the stomach mucosa and what is their role?
22. What are the substances scretate bye the gastric mucosa in order to defend in
face of HCl and pepsin aggression?
23. What effect may have aspirin on gastric mucosa?
24. What is the bacteria that may be involved in the production of gastric and
duodenal ulcers and how it may be destroyed?
25. What consequences appear in digesting food in face of gastric anacidity.
26. Biermer anemia is treated by administration of vitamin B12. If Biermer
megaloblastic anemia is caused bye the absence or deficiency of intrinsic factor,
should we administer vitamin - orally (tablets) or parenteral (injectable)?
27. What is the role of HCl in gastric digestion?
28. What roles have gastric mucus?

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