The Fractional Test-Meal as a Guide to Delay in Emptying of the Stomach

I'HE patient who complains of abdominal pain related to food is often referred for an X-ray examination. Among other things, the barium meal will show the rate of emptying of the stomaclh. In some there will be no delay, but in others there will be retention of barium in the stomach six hours after the meal. A few cases of this nature have been collected, in which fractionial test-meals were also done, and the radiological evidence of delay may be compared with the test-meal results. The patients, fifteen in number, attend(led the Royal Victoria Hospital, and most of them were seen in the extern departmenit. lhey complained of pain or discomfort in the upper abdomen some time after food. T'emporary relief was obtained by taking more food or alkali. In many the symptoms were of long duration, with alternate periods of good health and indigestion. For purposes of comparison, the test-meals have been divided into three groups. In the first group there was Ino radiological delay. In the second a small portion of the barium meal was still present in the stomach at six hours. In the third group, there was almost complete six-hour gastric retention. The findings are now given. GROUP 1-No RADIOLOGICAL DELAY.-The fasting acidity is low, but not always so, as illustrated by Case No. 4. The curve of acidity is "climbing" in type, andl there is hyperchlorhydria. The amount of free HCl. is closely related to the total acidity. Starch is not present in the fasting juice, but is found, three times out of five, in all the subsequent fractions withdrawn from the stomach. GROUP 2-SLIGHT SIX-HOUR RESIDUE.-The fasting acidity tends to be high. After an initial fall, the curve rises steadily, and is of the hyperacid type similar to Group 1. The curves of free and total acidity are again closely associated. Starch is absent from the fasting juice, but is present until the end of the test in four cases out of five. In the exception (Case No. 4) it disappeared in an hour and three-quarters. GROUP No. 3-LARGE SIX-HOUR RESIDUE.-The fasting acidity is high. There is a wide divergence between the curves of free HCI. and total acidity, and this is appreciably greater than in the former groups with slight or no retention. Starch is present in the fasting juice of two cases, and persists throughout the test in all but one. If …