Physiologic responses to gastric acid hypersecretion in Zollinger-Ellison syndrome

Abstract

Two patients with gastric acid hypersecretion and intact stomachs had diarrhea with steatorrhea. In 1 patient continuous outpouring of large volumes of alkaline juice into the duodenum, combined with the buffering capacity of food, resulted in normal or near normal pH levels in the upper small intestine for at least 90 min. after a meal. The tryptic activities in intestinal aspirates after the meal were essentially normal. Watery diarrhea was controlled when an anticholinergic drug was given both night and day, but steatorrhea was not reduced. In the other patient the alkaline secretions of the upper intestine were inadequate to neutralize the gastric acid output. The mechanisms by which acid secreted by the stomach is neutralized in the upper small bowel and the mechanisms of diarrhea are discussed.