In a healthy body, all physiological functions are in harmony. Gastric secretions are important for proper digestion and absorption of nutrients. Many factors affecting the function of the secretion-producing glands suppress its production. In this case, symptoms of indigestion develop. Other factors, on the contrary, stimulate secretion, resulting in the concentration of enzymes and pancreatic juice in the stomach cavity. This condition can also cause gastrointestinal diseases, since overstimulated production of hydrochloric acid provokes the formation of ulcers in the gastrointestinal system.
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What is this phenomenon?
Secretion in the stomach occurs due to the production of gastric juice by the glands. It is produced from 1 to 1.5 liters per day. The juice contains enzymatic substances (pepsin, lipase, chymosin, renin), hydrochloric acid and mucus. They are released from glandular formations due to contractile movements of muscle elements in the mucous membrane of the gastric lining. The function of the stomach is regulated by the visceral nervous system.
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Functions of gastric mucus
The mucus that is part of the gastric juice, together with HCO3- ions, forms a hydrophobic viscous gel that protects the mucosa from the damaging effects of hydrochloric acid and pepsins. The mucus produced by the glands of the fundus of the stomach includes a special gastromucoprotein, or intrinsic Castle factor,
which is necessary for the complete absorption of vitamin B12. It binds to vitamin B12, which enters the stomach as part of food, protects it from destruction and promotes the absorption of this vitamin in the small intestine. Vitamin B12 is necessary for the normal functioning of hematopoiesis in the red bone marrow, namely for the proper maturation of red blood cell precursor cells.
A lack of vitamin B12 in the internal environment of the body, associated with a violation of its absorption due to a lack of intrinsic Castle factor, is observed when part of the stomach is removed, atrophic gastritis and leads to the development of a serious disease - B12-deficiency anemia.
The stomach performs the following functions:
- Depositing . Food remains in the stomach for several hours.
- Secretory. The cells of its mucosa produce gastric juice.
- Motor . It ensures mixing and movement of food masses into the intestines.
- Suction. It absorbs a small amount of water, glucose, amino acids, and alcohols.
- excretory.
Some metabolic products (urea, creatinine and heavy metal salts) are removed into the digestive canal with gastric juice.
- Endocrine or hormonal . The gastric mucosa contains cells that produce gastrointestinal hormones - gastrin, histamine, motilin.
- Protective. The stomach is a barrier to pathogenic microflora, as well as harmful nutrients (vomiting).
Composition and properties of gastric juice: 1.5-2.5 liters of juice are produced per day.
Outside of digestion, only 10-15 ml of juice is released per hour.
How is everything going?
Gastric secretion is stimulated by a chewed bolus of food coming from the esophagus and moistened with saliva. It mechanically and chemically irritates the walls of the stomach, which provokes the release of enzymes and hydrochloric acid by the glands for the further breakdown of complex substances into simpler ones. The vagus nerve also influences their production. Internal secretion promotes parietal digestion. Enzymes and hydrochloric acid, released initially, promote the digestion of food in the lumen of the gastrointestinal tract.
Composition and properties of gastric juice. The meaning of its components
1.5 - 2.5 liters of juice are produced per day. Outside of digestion, only 10 - 15 ml of juice is released per hour. This juice has a neutral reaction and consists of water, mucin and electrolytes. When eating, the amount of juice produced increases to 500 - 1200 ml. The juice produced in this case is a colorless transparent liquid of a strongly acidic reaction, since it contains 0.5% hydrochloric acid. The pH of digestive juice is 0.9 - 2.5.
It contains 98.5% water and 1.5% solids. Of these, 1.1% are inorganic substances, and 0.4% are organic. The inorganic part of the dry residue contains cations of potassium, sodium, magnesium and anions of chlorine, phosphoric and sulfuric acids. Organic substances are represented by urea, creatinine, uric acid, enzymes and mucus.
Gastric juice enzymes include peptidases, lipase, and lysozyme.
Pepsins are classified as peptidases. This is a complex of several enzymes that break down proteins. Pepsins hydrolyze peptide bonds in protein molecules with the formation of products of their incomplete cleavage - peptones and polypeptides. Pepsins are synthesized by the chief cells of the mucosa in an inactive form, in the form of pepsinogens. The hydrochloric acid in the juice splits off the protein that inhibits their activity. They become active enzymes. Pepsin A is active at pH = 1.2 - 2.0. Pepsin C, gastrixin at pH = 3.0 - 3.5.
These 2 enzymes break down short chain proteins. Pepsin B, parapepsin is active at pH = 3.0 - 3.5. It breaks down connective tissue proteins. Pepsin D hydrolyzes milk protein casein. Pepsins A, B and D are mainly synthesized in the antrum. Gastricsin is formed in all parts of the stomach. Digestion of proteins occurs most actively in the mucosal layer of mucus, since enzymes and hydrochloric acid are concentrated there.
Gastric lipase breaks down emulsified milk fats. In an adult, its significance is not great.
Secrets functions
Substances contained in the glands are capable of stimulating the breakdown of complex food molecules into simple ones. If we take each component of gastric juice separately, they perform the following functions:
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- Pepsin. This enzyme is the main one, since it breaks down heavy proteins first into lighter ones (albumose and peptones), and eventually into small amino acids.
- Hydrochloric acid. It activates pepsin, converting it from its inactive form - pepsinogen. Bicarbonate also provides a more acidic or alkaline environment in the gastrointestinal tract. Hydrochloric acid destroys pathogenic microorganisms that enter the stomach with food.
- Renin. Helps digest breast milk in young children.
- Lipase. Works with fats, breaking them down into fatty acids and glycerol.
- Slime. Contains bicarbonates, which alkalize the gastric environment in case of excessive acidification. Mucus neutralizes hydrochloric acid when it is hypersecreted. It covers the gastric folds with a thin layer.
- Hormones and biologically active substances (gastrin, motelin, somatostatin, histamine, serotonin) provide regulation of the entire gastrointestinal system.
An anti-anemic factor is produced in the stomach. It stimulates the release of vitamin B12 from food, which is necessary for hematopoiesis.
Daily amount, composition and properties of gastric juice
Cellular mechanisms of hydrochloric acid secretion. Features of gastric digestion in children.
Gastric juice is a secretion secreted by the glands of the gastric mucosa.
Colorless, slightly opalescent liquid. Density (specific gravity) of gastric juice - 1.006 - 1.009, pH = 1.5-2.0. The daily amount reaches 2 liters.
The gastric juice of a healthy person contains a small amount of mucus and undigested fiber.
When analyzing gastric juice, indicators such as total acidity, the amount of free hydrochloric acid, etc. are necessarily determined.
The gastric secretion consists of two components: the parietal secretion, secreted by the parietal cells and having an acidic reaction, and the non-parietal secretion, secreted by all other cells of the stomach and having an alkaline reaction. The lining secretion contains hydrochloric acid in high concentration.
The latter does not damage the gastric mucosa due to the presence of protective factors (non-lining secretion, mucus and buffering properties of food). The non-plate secretion contains pepsin, gastrixin, mucin, chlorides, bicarbonates, sodium and potassium phosphates. The main source of formation of non-plate secretion is the mucous membrane of the pylorus; pepsinogen (the precursor of pepsin, a protein-digesting enzyme) is produced by the chief cells in the body of the stomach.
The second protein-digesting enzyme is gastrixin. Its proteolytic activity is almost two times higher than that of pepsin. Human stomach glands can produce lipase and possibly other enzymes. In addition, gastro-mucoprotein, or internal Castle factor (see Castle factors), a group of biologically active substances in the blood, is secreted into the stomach.
The cells that produce these substances are still unknown. The regulatory mechanism of gastric secretion is complex and not fully disclosed. The participation in this process of the nervous and endocrine systems, as well as local regulatory mechanisms in the stomach and intestines, has been established.
The synthesis of HCl is associated with the aerobic oxidation of glucose and the formation of ATP, the energy that is used by the active transport system of H+ ions.
Built into the apical membrane is H+/K+ ATPase, which pumps H+ ions out of the cell in exchange for potassium. One theory suggests that the main supplier of hydrogen ions is carbonic acid, which is formed as a result of the hydration of carbon dioxide, a reaction catalyzed by carbonic anhydrase. The carbonic acid anion leaves the cell through the basement membrane in exchange for chloride, which is then excreted through the apical membrane chloride channels.
What slows down or, on the contrary, stimulates the process?
If the production of enzymes and hydrochloric acid is reduced, symptoms of indigestion occur. The visceral nervous system, including the vagus nerve, stimulates an increase in the production of these substances. If its function is impaired, enzyme replacement therapy may be needed. The following factors slow down secretory function:
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- the nature of the food consumed;
- increased acidity in the duodenum;
- disorders of the nervous system.
Some foods and inflammatory processes in the gastrointestinal tract stimulate the secretion of enzymes and hydrochloric acid. Helicobacter pylori is a bacterium that causes gastritis. When they are introduced, there is a high risk of the formation of an ulcer, therefore, if detected, it is recommended to take antacids. These agents reduce the pH of the stomach and restore damaged mucous membranes. In case of hyposecretion, on the contrary, drugs are used that stimulate the exocrine function of glandular cells.
Treatment of disorders of gastric secretory function
Treatment of patients with secretory disorders of the stomach requires clarification of the cause of disturbances in acid-forming function. If there is an organic basis for these disorders, therapeutic measures are aimed at eliminating this cause and its consequences. The main attention should be focused on the analysis of anamnestic information. It is necessary to conduct a physical examination as carefully as possible, to provide for the possibility of developing gastritis and organic lesions of the stomach along with functional secretory disorders of the stomach.
Depending on the identified conditions, the principles, methods and means of treatment are determined. The principles of treatment of patients with secretory stomach disorders include local effects (on the gastric mucosa), effects on the nervous system (for neurotic conditions), on the vascular system of the stomach (elimination of venous stasis of the stomach, antispasmodic effects).
Treatment of gastric secretory function with diet
To treat the secretory function of the stomach, you need to follow a general regimen, a dietary regimen, physiotherapeutic treatment, and sanatorium treatment. The general regime includes sanitary and hygienic measures (oral hygiene, skin hygiene, home and household hygiene), regulation of work and rest with sufficient time in the open air, physical education, sports, physical labor, and adequate sleep. You should stop smoking and drinking alcohol, and avoid occupational intoxications (leaded gasoline, carbon monoxide, etc.).
Treatment of patients with secretory disorders of the stomach requires clarification of the cause of disturbances in acid-forming function.
The dietary regimen provides for chemical and mechanical sparing of the stomach, eating at a set time, in a calm environment. Spicy foods, spices, canned food, marinades, pickles, fried foods, strong broths, drinking large amounts of liquid, especially cold or hot, carbonated liquids, ice cream (especially on an empty stomach) are prohibited.
Symptoms of the disorder
Hypersecretion of gastric juice is manifested by heartburn, belching of acidic stomach contents or air. Sometimes there is pain in the epigastric region, a feeling of rapid satiety. Reduced secretion manifests itself as flatulence. It occurs due to the accumulation of insufficiently digested food in the intestines, fermentation and the release of gases. Reduced secretion prevents sufficient nutrients from entering cells and tissues. Anemia often develops with this pathology.
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The entire gastrointestinal tract (GIT) system in the human body is responsible for the speed and quality of digestion of food consumed. Disorders in its work quickly affect a person’s well-being and lead to disruption of the functioning of the whole organism. For normal functioning of the stomach, a certain level of secretion production and maintaining acidity balance are necessary.
In an average adult person, the glands produce up to two and a half liters of gastric juice per day, which includes the following components::
- water;
- chlorides;
- ammonia;
- hydrochloric acid;
- sulfates;
- sodium, magnesium, potassium bicarbonate;
- other elements.
Gastric juice is an aggressive environment, the pH of which is determined by the amount of hydrochloric acid. Its content in different parts of the gastrointestinal tract varies significantly and can range from 0.5 to 2.6% of the total volume of all components.
Secretion research methods
Methods for studying secretion (methods for obtaining secretions):
- acute experiments under anesthesia,
- resection of the gastrointestinal tract and content analysis,
- chronic experiments: applying a fistula to each part of the gastrointestinal tract.
Physiological methods:
-Sensing with the placement of sensors that monitor pH, pressure, etc.
-Endoradiosounding: radio capsule with sensors for pH, pressure, etc.
Biochemical methods:
-Study of the chemical properties of secretions
-Study of the content of active gastrointestinal enzymes in the blood and urine
Fractional sensing method
The collection of material for research is carried out on an empty stomach.
The procedure is carried out on an empty stomach and in several stages. For further analysis of gastric juice, the entire contents of the digestive organ are removed, approximately 50 ml (fasting portion). Next, every 15 minutes, 4 portions of secretion are extracted, which is released due to irritation of the walls of the organ with the probe. This substance is called "basal gastric secretion". The third stage is characterized by the fact that it is carried out with the help of stimulants that activate the production of gastric juice. There are 2 types of aspiration (secret extraction):
- Myasoedov's method. The essence of the method is that the secretion is removed every 15 minutes for an hour, 10 minutes after stimulation.
- Leporsky method. The study is simpler, since stimulants are administered immediately after the first stage of the procedure.
Probeless research methods
Not everyone can use probing. People suffering from certain diseases are prohibited from undergoing this procedure. Contraindications include cardiovascular diseases (heart disease, ischemia, hypertension, aortic aneurysm), lung diseases, a tendency to gastric bleeding, and diseases of the esophagus. Probing is also excluded during pregnancy.
If contraindications for probing are identified, a technique is used in which the probe is not inserted. This does not irritate the walls of the digestive organ and does not cause discomfort, as with the standard procedure. But probeless methods, unfortunately, are less accurate and determine only the general condition of the organ contents, without detailed indicators.
pH-metry
To determine the pH level, a probe equipped with electrodes and a device that reads and records the acidogastrometer information is also used. In this case, gastric juice is not extracted. This procedure is carried out to study gastric secretion and acidity of the gastrointestinal tract. To conduct the study, a small probe is used, which causes minimal discomfort, unlike a conventional one. Indications for acidity testing: reflux, ulcers, chronic gastritis, gastrectomy, duodenitis, dyspepsia. An exception is the aspiration-titration method, which is carried out by extracting gastric juice with a conventional probe. This method is considered less effective.
The level of hydrochloric acid affects the digestion process.
There are several main types of this type of sensing:
- Daily pH-metry. The state of gastric juice is examined at several points in the organ. Lasts 24 hours. Used to determine the influence of lifestyle, medications, and nutrition on the gastrointestinal tract.
- Short-term pH-metry. Acidity is measured in several parts of the organ after stimulating secretion with histamine.
- Express research. Passes within 15-20 minutes, hydrochloric acid is detected and the basal acidity level is determined.
- Endoscopic pH-metry. It is carried out during gastroscopy, using a special probe to measure acidity at 9 points of the stomach and duodenum.
Desmoid test
The color of urine after the procedure will help determine acidity levels.
Aimed at analyzing the secretion of hydrochloric acid. The procedure is carried out in this way: a pre-prepared rubber bag, tied with catgut thread with a colored liquid inside, is allowed to be swallowed by the patient. The point is to determine how long it takes for the catgut to be digested. Thanks to this information, the activity of hydrochloric acid is determined. After the bag is inside, the patient has breakfast. After 3, 5 and 20 hours, urine is collected. The brightness of its color determines the state of secretion of the organ. Normal indicators: 3 hours - urine is not colored, 5 - pale green urine, 20 - blue-green.
Ion exchange resin method
It is characterized by the fact that the study uses drugs that contain resins saturated with indicators (quinine, dye). When these tablets are consumed, the indicator ions are exchanged for a similar amount of hydrogen ions of hydrochloric acid, and the indicator itself is released, absorbed into the intestinal walls and entering the blood. The compounds are excreted in the urine. The level of secretion is determined using the amount of indicator in the urine and the degree of its coloration.
Secretory function of the stomach
The secretory function consists of the production of gastric juice by special glands, which leads to the chemical processing of food. Under the influence of gastric juice enzymes, food is partially broken down and moves into the pyloric region.
Gastric juice consists not only of enzymes, it contains mucus, which covers the gastric mucosa, protecting it from mechanical and chemical damage, as well as hydrochloric acid, water, chlorides, sulfates, phosphates, bicarbonates, sodium, calcium, potassium, magnesium, ammonia.
Enzymes in gastric juice are called pepsins and have the ability to partially break down proteins that are pretreated with hydrochloric acid. At the same time, the composition of gastric juice is not the same in different parts of the stomach. The concentration of hydrochloric acid is higher in the cardiac part of the stomach, and the closer to the pyloric part, the more alkaline the juice. This is of great physiological importance, since as food moves towards the duodenum, it is neutralized.
Regulation of gastric juice secretion
Regulation of gastric juice secretion is neuroendocrine. That is, both the nervous system and hormones play a big role. Outside of meals, the stomach produces a small amount of digestive juice, and during meals its volume increases sharply, and before the food enters directly into the stomach.
The smell and appearance of food are powerful stimuli. At the same time, the composition and amount of gastric juice can vary depending on the volume and composition of the food - the more protein it contains, the more pepsin there will be, animal proteins stimulate the production of hydrochloric acid, and gastric juice will be more acidic for breaking down meat than bread.
Gastric juice does not have enzymes that break down carbohydrates, but the dissolution of carbohydrates in the stomach still occurs thanks to salivary enzymes that enter with food from the oral cavity. The normal functioning of the stomach depends on how well the food was chewed and processed with saliva. Dry, large lumps injure the gastric mucosa and force it to work much longer, producing large amounts of mucus and gastric juice. Thus, the habit of eating on the go and dry food negatively affects the functioning of the stomach, disrupting its function.
Normally, food should remain in the stomach for no more than 2-5 hours. But if it is oily and poorly processed, then this process can last about 8 hours. That is, it's time for dinner, but lunch is still in the stomach.
Disorders of the acid balance of secretion in the stomach
They may be caused by the following factors:
- Malfunction of the glands. As a result, an insufficient or excessive amount of secretion is released or its chemical composition changes.
- The quality of food consumed. When low-quality or difficult-to-break-down products enter the stomach, the acidic environment cannot effectively cope with its function and the chemical composition of gastric juice changes.
- Amount of food. When overeating and abusing foods that are difficult to break down, the volume of secretion increases.
All these factors affect the amount of gastric juice secreted and can lead to 2 conditions:
- Increased (hypersecretion) – excessive secretion and increased concentration.
- Insufficient secretion - the production of insufficient gastric juice to digest foods.
Symptoms of secretion disorders
Conditions such as::
- malaise in the form of nausea, vomiting, heaviness in the abdomen, bloating;
- lack or increased appetite, discomfort after eating food;
- change in stool. It can manifest itself both in the form of liquid discharge and constipation;
- the appearance of heartburn in the esophagus or a burning sensation in the stomach itself;
All these conditions are indirect signs of an imbalance in the acid balance in the gastrointestinal tract. They serve as a reason for contacting a medical institution, diagnosis and subsequent treatment . Before conducting examinations, you should not resort to self-diagnosis and self-medication.
Methods for determining the level of secretion in the gastrointestinal tract
In modern medicine, there are 2 types of determining the level of acidity in the stomach:
- Probing . To carry out diagnostics, a thin probe is inserted into the patient's stomach, with the help of which fluid is taken to determine its composition in the laboratory. It is also possible to detect the PH level by injecting a liquid with an acid indicator.
- Probeless method (Acidotest) . It is carried out on the basis of a urine test, after taking the medications necessary for diagnosis.
The method of conducting the study is chosen by the doctor, taking into account the well-being, wishes and capabilities of the patient. It is extremely difficult to accurately determine increased or decreased secretion at home.
Factors that provoke increased gastric secretion
If a patient has an increased secretion of gastric juice and its concentration exceeds the permissible norms, this may be due to:
- with disruption of the gastrointestinal glands;
- overwork or stress;
- overeating;
- excessive consumption of animal fats, proteins and carbohydrates;
- alcohol abuse;
- excessive content of hot, sour, spicy foods in the diet.
An effective way to stabilize increased secretion is to follow a diet
Normalizing increased secretion with diet
By changing the patient's diet and diet, excess gastric juice and acidity in most cases are normalized.
To do this, you must follow the following recommendations:
- eat food in small portions 5-6 times a day;
- try to follow a diet and eat at certain hours;
- balance the menu in terms of calories and content of proteins, fats, fiber, macro and micro elements;
- give up strong alcohol and smoking;
- Cook dishes by steaming or boiling, exclude fried foods;
- give preference to mushy and liquid consistency of dishes;
- Do not drink carbonated drinks, foods high in dyes, flavor enhancers, preservatives, or acids.
- exclude hot spices and seasonings.
- refrain from foods that are considered difficult to break down, for example, mushrooms, animal fats, legumes.
Compliance with such a dietary regimen will have a positive effect on the condition of the entire gastrointestinal tract and normalize acidity.
Functional gastric hypersecretion
Functional gastric hypersecretion (irritable stomach syndrome, hyperacid condition) is a pathological condition that is popularly called “increased gastric acidity,” and doctors characterize it as an increase in gastric secretion and acidity of gastric juice.
Often, irritable stomach syndrome can occur without any symptoms at all.
But it happens that it manifests itself as ulcer-like pain and burning in the epigastrium (upper abdomen), heartburn, sour belching (appears within an hour after eating), bloating and heaviness in the epigastric region.
Attacks occur more often on an empty stomach and at night. It is also quite common to experience nausea and vomiting on an empty stomach with large amounts of gastric juice. After vomiting, the pain in the stomach subsides as excess acid is removed.
Description
Irritable stomach syndrome is a fairly common pathology, it occurs in approximately 80% of the population. Irritable stomach syndrome was first described by the head of the department of gastric diseases at the Research Institute of Nutrition of the Russian Academy of Medical Sciences, O.L. Gordon. Then he proposed calling this syndrome “functional diseases of the stomach.”
Basically, gastric secretion increases due to poor nutrition. The following are to blame for this:
In addition, gastric functional hypersecretion can occur during mental excitement, stress, and also at the initial stage of thyrotoxicosis.
Pain syndrome with gastric functional hypersecretion is caused by spasm of the pylorus (sphincter that regulates the flow of gastric contents into the duodenum) and increased peristalsis of the digestive tract. The pain usually worsens in the autumn-spring period.
Treatment
Treatment is aimed at normalizing lifestyle, diet and nervous system activity.
So, food should not irritate the stomach. That is, you should not eat fatty, fried, spicy, salty, solid foods and carbonated drinks. Food should slightly excite the stomach and leave it relatively quickly. It is preferable to steam or boil all dishes, and then puree or grind in a blender.
Medications usually include drugs that block acid production or antacids that neutralize it. In addition, if the disease is caused by mental stress, sedatives are prescribed.
Medical methods for treating increased secretion
If the causes of the disease are associated not only with poor diet, but also with lifestyle or malfunction of the glands, doctors prescribe medication.
It may include:
- Drugs that reduce acidity - antacids.
- Medicines that block the production of hydrochloric acid by the gastrointestinal glands.
- Sedatives that help relieve stress and stress on the nervous system and stabilize the digestive system.
As a rule, complex treatment is prescribed. To relieve acute conditions with a feeling of heartburn and indigestion, a complex of drug treatments is used, and in parallel, the patient is strongly recommended to follow a diet and lead a measured lifestyle. Avoid stress, overwork, lack of sleep, follow a dietary regime.
Violation of the secretory function of the stomach, signs and treatment
Disorders of gastric secretion are not always a consequence of pathological changes in the digestive system. They are also observed in pathological changes in the nervous, endocrine, and urinary systems of the body. The abnormalities may be in the form of decreased secretion (hyposecretion), increased secretion (hypersecretion), or excessive continuous secretion on an empty stomach (“spontaneous” secretion).
Secretory stomach disorders are characterized not only by quantitative, but also by qualitative changes: increased acidity, decreased acidity or lack of free hydrochloric acid. Disturbances in the absorption function of the stomach are distorted during gastritis, as the mucous membrane becomes permeable to toxins and some digestion products. Absorption is limited by excessive mucus production, atrophic gastritis and gastric resection.
Among the main reasons for violation of the secretory function of the stomach is poor nutrition.
Causes of dysfunction of the secretory function of the stomach
The secretion of gastric juice is inhibited during fear, mental trauma, infectious diseases (influenza, typhoid fever, scarlet fever, etc.), as well as when salt and iodine metabolism is disrupted, for example, with edema and large accumulations of fluid in the abdominal cavity. As numerous observations have shown, fasting also leads to disruption of the glandular apparatus of the stomach and a significant decrease in juice secretion.
Patients with low levels or complete absence of hydrochloric acid may not show any special complaints for a long time. The signs observed in this case are not characteristic of this disease; they are usually typical for neurosis - decreased performance, fatigue.
The main cause of the disease is the bacterium Helicobacter pylori, less commonly other bacteria and fungi. Helicobacter pylori is detected in 80% of cases of gastritis. Bacteria enter the gastric mucosa, releasing special substances that irritate the mucosa and cause a change in the pH of the walls, which leads to inflammation.
Among the main causes of impaired secretory function of the stomach is poor nutrition. This could be overeating or undereating, or improper eating patterns. Lack of plant foods rich in plant fiber, which promotes good digestion, leads to gastritis. Frequent consumption of refined and processed foods, fatty and hot sauces also leads to inflammation of the stomach.
According to research, some drugs that are used to prevent blood clotting, painkillers, and anti-inflammatory drugs can negatively affect the condition of the gastric mucosa, as they irritate it and change the secretory function of the stomach. The cause of changes in the secretory function of the stomach can be various helminthic infections, constant stress, some potent chemicals, and allergies to certain foods.
Consequences of advanced disease
If patients refuse treatment or do not follow a diet, increased secretion of gastric juice can provoke the development:
- Gastritis.
- Neoplasms of various origins.
- Peptic ulcer disease.
If signs of illness appear, consult a gastroenterologist. He will prescribe the necessary diagnostic method and, based on the results obtained, determine the regimen and duration of treatment. Gastric secretion disorders identified in the early stages can be eliminated with conservative treatment methods or diet.
The concept of gastric hypersecretion means not only an increased content of hydrochloric acid, but also a large number of other components of gastric juice. There are several of them:
- proteolytic and non-proteolytic enzymes: lipase, pepsin, rennet and others;
- hydrochloric acid;
- Castle factor;
- bicarbonates;
- slime.
Normal secretion – how much?
Gastric juice is a colorless liquid. Normally, men produce from 80 to 100 ml in one hour. Female secretion has different indicators: juice production reaches 56-80 ml per hour. Thus, the maximum amount of gastric juice that is normally produced in a healthy person is about 2 liters. Anything above this indicator is called hypersecretion.
The table shows the norms of normal gastric juice acidity in various parts of the stomach:
| Acidity of the antrum | pH 1.3 – 7.4 |
| Acidity on the surface of the epithelium of the body of the stomach | pH up to 2 |
| Acidity in the deep layers of the epithelium of the body of the stomach | pH up to 7 |
| Acidity in the body of the stomach (on an empty stomach) | pH up to 2 |
Secretion in children
The chemical composition of a child's gastric juice is identical in composition to the secretion of an adult's stomach. However, there are also physiological characteristics: among children's enzymes, the most active enzyme is rennet, which is capable of turning milk into cottage cheese. This explains regurgitation in infants.
Not always sour
If the secretory apparatus of the stomach works intensely, this does not mean that there will necessarily be a lot of hydrochloric acid in the body. In some cases, its level remains normal or even decreases, while the rest of the secretion is produced in greater quantities than necessary.
Quantity, composition and properties of gastric juice
This juice has a neutral reaction and consists of water, mucin and electrolytes. When eating, the amount of juice produced increases to 500-1200 ml. The juice produced in this case is a colorless transparent liquid of a strongly acidic reaction, since it contains 0.5% hydrochloric acid. The pH of digestive juice is 0.9-2.5. It contains 98.5% water and 1.5% solids.
Of these, 1.1% are inorganic substances, and 0.4% are organic. The inorganic part of the dry residue contains cations of potassium, sodium, magnesium and anions of chlorine, phosphoric and sulfuric acids. Organic substances are represented by urea, creatinine, uric acid, enzymes and mucus.
Gastric juice enzymes include peptidases, lipase, and lysozyme.
Pepsins are classified as peptidases. This is a complex of several enzymes that break down proteins.
Hydrochloric acid is formed in parietal cells. Hydrochloric acid dissolved in gastric juice is called free. When combined with proteins, it determines the associated acidity of the juice. All the acidic products in the juice contribute to its overall acidity.
Hydrochloric acid value of juice:
- Activates pepsinogen.
- Creates an optimal reaction environment for the action of pepsins.
- Causes denaturation and loosening of proteins, providing access for pepsins to protein molecules.
- Promotes curdling of milk.
- Has an antibacterial effect.
- Stimulates gastric motility and secretion of gastric glands.
- Promotes the production of gastrointestinal hormones in the duodenum.
Mucus is produced by accessory cells. Some vitamins (groups B and C) accumulate in the mucus
Food coming from the oral cavity is located in the stomach in layers and is not mixed for 1-2 hours.
Therefore, carbohydrate digestion continues in the inner layers under the action of salivary enzymes.
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The main cells of the gastric glands synthesize pepsinogen, an inactive precursor of pepsin, which is the main hydrolytic enzyme of gastric juice. The proenzyme synthesized on ribosomes accumulates in the form of zymogen granules and is released into the lumen of the gastric gland by exocytosis. In the stomach cavity, the inhibitory protein complex is cleaved from pepsinogen and the proenzyme is converted into pepsin.
Activation of pepsinogen is triggered by HCl, and subsequently proceeds autocatalytically: pepsin itself activates its proenzyme.
The term pepsin currently refers to a mixture of several proteolytic enzymes. In humans, 6-8 different enzymes have been found that differ immunohistochemically. At an optimal pH value, pepsin hydrolyzes proteins by breaking peptide bonds in the protein molecule formed by groups of phenylamine, tyrosine, tryptophan and other amino acids.
As a result, the protein molecule breaks down into peptones and peptides. Pepsin ensures the hydrolysis of basic protein substances, especially collagen, the main component of connective tissue fibers.
The main pepsins in gastric juice include the following:
- pepsin
A - group of enzymes that hydrolyze proteins at an optimum pH of 1.5-2.0;
- gastrixin (pepsin C),
hydrolyzing proteins at an optimum pH of 3.2-3.5;
— pepsin B (parapepsin)
breaks down gelatin and connective tissue proteins (at pH 5.6 and higher, the proteolytic effect of the enzyme is weakened);
— rennin (pepsin D, chymosin)
breaks down milk casein in the presence of Ca2+ ions.
Gastric juice contains a number of non-proteolytic enzymes.
Among them are gastric lipase,
breaking down fats that are in food in an emulsified state (milk fats) into glycerol and fatty acids at a pH of 5.9-7.9.
In infants, gastric lipase breaks down up to 59% of milk fat. There is little lipase in the gastric juice of adults. Therefore, the bulk of fats are digested in the small intestine.
Cells of the surface epithelium of the gastric mucosa produce lysozyme (muromidase).
Lysozyme determines the bactericidal properties of gastric juice.
Urease
breaks down urea in the stomach at pH 8.0.
The ammonia released during this process neutralizes hydrochloric acid and prevents excess acidity of the chyme entering the duodenum from the stomach.
Causes of hypersecretion and increased acidity
Gastritis through an endoscope
Wrong eating habits, alcohol abuse and smoking alone are not enough to develop juice hypersecretion. Of course, in these cases it will definitely arise, but against the background of the formed pathologies that caused your addictions. The list of diseases that provoke increased production of gastric secretions and hydrochloric acid is in front of you:
- any gastritis;
- the presence of Helicobacter bacteria in large quantities;
- peptic ulcer;
- hiatal hernia;
- reflux;
- poisoning;
- malignant neoplasms;
- endocrine disorders;
- allergy.
About symptoms and more
Symptoms of high secretion of gastric juice depend on the level of hydrochloric acid. High acid levels cause nausea, heartburn, discomfort and abdominal pain. Sometimes, when eating food that is difficult to digest, a person develops vomiting.
There are also secondary symptoms of increased secretion, which do not always occur. This is flatulence, sour belching, periodic constipation. People with high acidity may experience increased appetite and may have bad breath due to the presence of a coating on the tongue.
But only subjective symptoms are not decisive in making a particular diagnosis of gastric pathology.
For example, an increase in secretion in pregnant women can be temporary and disappears after the birth of the child.
In a state of stress and in harmful working conditions, the secretory function of the stomach can also vary upward and cause the symptoms that we have described.
Therefore, any discomfort in the stomach requires additional examination.
Dyspepsia with increased acidity (hyperchlorhydria)
Conditions related to this are most often encountered at a young age in women. Very often they are associated with signs of chlorosis, general nervousness, etc. But dyspepsia acida is also observed in older people of both sexes. Hyperchlorhydria can also be caused by well-known diet errors (hot, spicy foods, then especially strong coffee).
Dyspeptic conditions with hyperchlorhydria were also often observed in immoderate smokers. The disorders appear to be quite characteristic. They occur mainly after eating and sometimes only after certain foods and consist first of a feeling of heaviness in the stomach, which, however, can sometimes reach the level of real stomach pain.
Usually these pains occur only 2-3 hours after eating, therefore, at a time when the stomach is already empty, a significant separation of acid is still ongoing. Some of the patients then made the observation that they could reduce their pain by introducing new foods or drinking liquids, which is easily understandable.
Very often, during strong acid formation, sour belching appears, causing a clear sensation of heartburn. Vomiting of acidic stomach contents also occurs, although not particularly often. When the stomach is completely empty, patients again feel quite satisfactory.
Since the appetite is usually not impaired, the nutritional status, as a rule, remains quite good. The general course of the disease is, however, chronic, but very variable. Sometimes, especially under the influence of mental factors (sorrow, anxiety) or as a result of an unreasonable lifestyle, painful phenomena become more pronounced, and sometimes they completely disappear.
The diagnosis of hyperchlorhydria can be assumed based on the above-mentioned symptoms; it can only be established precisely by examining it with a probe. External examination of the stomach does not reveal anything special, except for the occasional mild diffuse sensitivity to pressure.
The fact that gastric prolapse often occurs simultaneously does not matter (see next chapter). If the stomach is examined on an empty stomach, then with pure hyperchlorhydria it turns out to be empty or almost empty. The amount of acid after a test breakfast, on the contrary, is very high (70-100 or more), the digestive power of gastric juice is increased. According to this, it's already 3-4 hours,
After a test meal, the stomach is usually found to be completely empty, which indicates good motor power of the stomach. Usually there is still hydrochloric acid present. Digestion of starch is difficult due to the abundant HCl content.
From the above relationships, the diagnosis of hyperchlorhydria as such is clear without further explanation. The only question that seems difficult is whether we are dealing with an ordinary functional increase in secretion or with symptomatic increased acidity in the presence of a stomach ulcer.
If the characteristic symptoms of an ulcer (stomach bleeding, limited pain with pressure, etc.) are absent, then this issue can only be resolved with a certain probability. It seems characteristic that in ordinary hyperchlorhydria, pain improves with administration; food, with an existing stomach ulcer, on the contrary, worsens.
The presence of clearly expressed general nervous symptoms usually definitely indicates a “nervous” increase in acidity. Finally, the success of treatment may have an impact on the diagnosis (see below). We will talk about treatment methods at the same time as treating supersecretion.
Diagnostics
The FGDS method is the leading one in the diagnosis of major gastric pathologies. During the examination, both secretory function and the acidity of gastric contents are determined. In addition, modern medicine has learned to recognize the presence of pathological Helicobacter in exhaled air. The diagnostic procedure is easy to perform, although it is not yet very widespread and exists only in large cities.
Expensive capsule EGD, by the way, is not indicated if you need to determine acidity. The capsule cannot do this.
