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Gastric Acid Analysis Test (Peptavlon Stimulation Test)

Norm of Gastric Acid Analysis Test (Peptavlon Stimulation Test)

Within normal limits.

Basal (Prestimulation) Acid Output (BAO) Is the Gastric Acid Secreted Without Stimulation
SI Units
Adult Female

Normal

1–4 mEq/hour

1–4 mmol/hour
Duodenal ulcer 3–8 mEq/hour 3–8 mmol/hour
Gastric carcinoma 0–3 mEq/hour 0–3 mmol/hour
Gastric ulcer 1–3 mEq/hour 1–3 mmol/hour
Atrophic gastritis 0 mEq/hour 0 mmol/hour
Pernicious anemia 0 mEq/hour 0 mmol/hour
Zollinger-Ellison syndrome >20 mEq/hour >20 mmol/hour
Adult Male
Normal 2–5 mEq/hour 2–5 mmol/hour
Duodenal ulcer 5–10 mEq/hour 5–10 mmol/hour
Gastric carcinoma 0–3 mEq/hour 0–3 mmol/hour
Gastric ulcer 1–5 mEq/hour 1–5 mmol/hour
Atrophic gastritis 0 mEq/hour 0 mmol/hour
Pernicious anemia 0 mEq/hour 0 mmol/hour
Zollinger-Ellison syndrome >20 mEq/hour >20 mmol/hour

 

Maximum (Stimulated) Acid Output (MAO) Is the Gastric Acid Output After Stimulation (Sum of Four 15-Minute Specimens)
Adult Female
Normal 7–15 mEq/hour 7–15 mmol/hour
Duodenal ulcer 10–20 mEq/hour 10–20 mmol/hour
Gastric carcinoma 0–5 mEq/hour 0–5 mmol/hour
Gastric ulcer 5–15 mEq/hour 5–15 mmol/hour
Atrophic gastritis 0 mEq/hour 0 mmol/hour
Pernicious anemia 0 mEq/hour 0 mmol/hour
Zollinger-Ellison syndrome 35–60 mEq/hour 35–60 mmol/hour
Adult Male
Normal 5–26 mEq/hour 5–26 mmol/hour
Duodenal ulcer 15–35 mEq/hour 15–35 mmol/hour
Gastric carcinoma 0–20 mEq/hour 0–20 mmol/hour
Gastric ulcer 10–20 mEq/hour 10–20 mmol/hour
Atrophic gastritis 0 mEq/hour 0 mmol/hour
Pernicious anemia 0 mEq/hour 0 mmol/hour
Zollinger-Ellison syndrome 35–60 mEq/hour 35–60 mmol/hour
BAO:MAO Ratio
Normal 1:2.5–1:5.0 0.3–0.6
Gastric ulcer/gastric carcinoma 20%
Gastric ulcer/duodenal ulcer 20%–40%
Duodenal ulcer/Zollinger-Ellison syndrome 40%–60% syndrome
Zollinger-Ellison syndrome >60%

 

Peak Acid Output (PAO) Is 2 × Total Values of the Two Highest 15-Minute MAO Samples; BAO:PAO Ratio
SI Units
Adult Female 0.23
Adult Male 0.29

 

Usage of Gastric Acid Analysis Test (Peptavlon Stimulation Test)

Diagnosing and evaluating atrophic gastritis, duodenal ulcer, gastric carcinoma, gastric ulcer, Ménétrier's disease, pernicious anemia, postoperative stomal ulcer, and Zollinger-Ellison syndrome.
Increased
Duodenal ulcer, gastric ulcers in some cases, Helicobacter pylori infection, obesity, peptic ulcer disease, pyloric ulcer, and Zollinger-Ellison syndrome. Drugs include adrenergic blockers, alcohol, alseroxylon, caffeine, calcium salts, cholinergics, cigarette smoking, corticosteroids, deserpidine, ethyl alcohol (ethanol), NSAIDs, rescinnamine, and reserpine.
Decreased
Achlorhydria, anemia (pernicious), gastric atrophy, gastric neoplasm, gastric ulcer, and gastritis. Drugs include antacids, anticholinergics, beta-blocking agents, cimetidine, famotidine, lansoprazole, nizatidine, ranitidine hydrochloride, and tricyclic antidepressants.

 

Description of Gastric Acid Analysis Test (Peptavlon Stimulation Test)

Gastric acid consists of hydrochloric acid (HCl), electrolytes, and mucus and is colorless and very acidic, with a pH of <2.5. It is normally secreted by the parietal cells of the stomach in response to the presence of gastrin during the gastric phase of digestion. In the presence of tumors, ulcerative disease, or pernicious anemia, the rate of gastric acid secretion can be accelerated or diminished. The Peptavlon (pentagastrin) stimulation test involves a 1-hour aspiration of stomach secretions. A basal and four 15-minute collections are made after subcutaneous injection of Peptavlon. Peptavlon normally stimulates gastric acid secretion within 10 minutes, with peaks occurring at approximately 30 minutes. By measuring the rate and volume of gastric acid secretion in response to Peptavlon, one can evaluate gastric function. Pernicious anemia and atrophic gastritis result in hyposecretion of gastric acid. Hypersecretion and the rate of secretion can indicate location and type of ulcerative disease, Zollinger-Ellison syndrome, and the need for surgical intervention.

 

Professional Considerations of Gastric Acid Analysis Test (Peptavlon Stimulation Test)

Consent form NOT required.
Preparation

  1. See Client and Family Teaching.
  2. Obtain a Levin tube, lubricant, eight clean plastic containers without preservative, a Toomey syringe, suction equipment, a marker or grease pencil, and Peptavlon (pentagastrin).
  3. Prepare the suction apparatus and tubing.

 

Procedure

  1. Position the client sitting or lying on the left side.
  2. Insert a Levin tube with a radiopaque tip through the client's nose or mouth into the stomach. Position the Levin tube tip in the lumen below the stomach fundus and confirm the placement by radiography or fluoroscopy.
  3. Reposition the client to a sitting position and wait at least 10 minutes before proceeding further.
  4. Apply low continuous suction to the Levin tube. At 15 and 30 minutes, withdraw two specimens with a Toomey syringe and discard the aspirate.
  5. Begin continuous aspiration of gastric contents, using the syringe, for a total of 60 minutes. Collect the aspirate into the collection containers (labeled 1, 2, 3, 4), using a new collection container every 15 minutes until the basal acid output collection is complete.
  6. Administer Peptavlon 6 mg/kg of body weight subcutaneously and begin post stimulation collections, as in the previous step, immediately. The poststimulation collection should continue for 1 hour. Observe for hypersensitivity reaction.

 

Postprocedure Care

  1. Send all 8 containers identified as basal or post stimulation to the laboratory for analysis.
  2. Remove the Levin tube.
  3. Refrigerate the specimens if testing will be delayed more than 4 hours.
  4. Resume previous diet.
  5. Observe for nausea and vomiting.

 

Client and Family Teaching

  1. Fast from food after the evening meal the day before testing and from water for 1 hour before the test.
  2. Do not smoke or chew gum, and avoid stressful situations for 4 hours before the test.
  3. The test involves the insertion of a tube through the nose into the stomach and periodic removal of the stomach contents with a syringe through the tube. The test may cause symptoms of indigestion because a drug that stimulates gastric acid secretion is given. Mild, temporary discomfort may be experienced during the tube insertion.
  4. The test takes more than 3 hours. Bring reading material or other diversional activity.

 

Factors That Affect Results

  1. Histamine antagonists or anticholinergics and antacids should be discontinued 72 and 12 hours before the test. If, however, the objective is to test the effectiveness of a histamine antagonist on acid secretions, the drugs should be continued, and the basal output of gastric acid should be performed 1 hour after administration of a morning dose.
  2. Stimuli that may increase gastric acid production include smoking, the sight or odor of food, or stimuli that cause the client to become angry, fearful, or depressed.

 

Other Data

  1. Peptavlon use in children is not indicated.
  2. The test must be used with caution in conditions of esophageal varices, esophageal diverticula, esophageal stenosis, malignant neoplasm of the esophagus, aortic aneurysm, gastric hemorrhage, and congestive heart failure.