Studies of Gastric Pepsin. Ii. Secretion of Pepsin in Cases of Duodenal Ulcer and Pseudo-ulcer.

Few articles on concentration of pepsin in the gastric juice of patients with disease of the stomach and duodenum are to be found in recent literature, and the results reported by different observers are not always in accord. We shall consider here only the concentration of pepsin in the gastric juice of persons suffering with the syndrome of peptic ulcer. Wilcox (5), in 1908, reported that the concentration of pepsin in the gastric juice of persons with peptic ulcer and hyperacidity was usually higher, and never lower, than normal. Boas (1), in 1925, and HirschMamroth and Rindfleisch (3) likewise found that the concentration of pepsin was elevated in the presence of ulcer, provided blood was not present in the sample examined, but they quoted other workers who at times failed to find any increase. Polland and Bloomfield (4) reported that the range of concentration of pepsin was the same in patients with ulcer as in normal persons. We have estimated the concentration of pepsin by a modification of the Gilman-Cowgill method (2), described in the preceding article (6). As an arbitrary standard of measurement a 1 per cent solution of Armour's 1: 10,000 commercial pepsin was assumed to contain 1,000 units. In the greater part of the investigation we examined gastric contents removed one hour after the ingestion of a test meal which consisted of eight arrowroot cookies and 400 cc. of water. We also determined the content of pepsin in the juice removed from the stomach in the morning, before breakfast. Although the same general conclusions may be drawn from studies of contents removed after a test meal and of juice from the fasting stomach, it is necessary to consider the results obtained with the two technics separately because of differences observed in the absolute values for pepsin. Duodenal ulcer The diagnosis of duodenal ulcer was made in 274 cases on the basis of the history and fluoroscopic examination. In fifty-seven cases the