THE DIVERSION OF THE PANCREATIC JUICE FROM THE DUODENUM INTO THE STOMACH. ITS EFFECTS UPON THE LEVEL OF GASTRIC ACIDITY AND UPON THE PANCREAS.
The mechanism described for maintaining the optimum level of gastric acidity is designated by Boldyreff as the "self regulation of the acidity of the contents of the stomach." In support of Boldyreff's hypothesis is the evidence obtained from many experiments carried out both on man and on animals, in which solutions of alkali and acid have been placed in the stomach. The introduction of acid fluid has led to a regurgitation of alkaline duodenal contents, whereas the introduction of alkaline solutions has called forth a secretion of acid gastric juice. The experiments reported in this paper were carried out for the purpose of ascertaining how the stomach would react, in as far as the secretion of hydrochloric acid is concerned, to a more or less continuous influx of relatively strong alkaline fluid, prolonged throughout the cycle of digestion. Numerous studies have shown that any serious interference with the process of regurgitation leads to a rise in the acidity level of the stomach; i.e., to a state of hyperacidity. There is but little evidence, however, to indicate whether the acidity level will be depressed temporarily or permanently (hypoacidity) when alkaline material, in considerable amounts, continues to enter the stomach. The influx of alkaline fluid was provided for by transplanting the larger pancreatic duct into the wall of the stomach after ligating and dividing the lesser duct. Specimens of test meal for analysis were withdrawn through gastric fistulas made after the method of Janeway. Animals prepared in this manner served also to furnish additional information regarding the possible relation of the hydrochloric acid of the gastric juice to certain acute inflammatory and chronic sclerotic changes in the pancreas. From the results of these experiments it appears that the presence of a considerable amount of pancreatic juice in the stomach throughout the period of digestion leads only to a moderate decrease in the acidity level of the ingesta in the later stages of digestion. Earlier in the process there is no constant alteration of the acidity level in either direction. The findings then serve not only to corroborate the views of Boldyreff, but also to demonstrate the remarkable compensatory activity of the gastric glands under conditions which entail an unusual quantity of alkali in the stomach. In addition the work has shown that when the larger pancreatic duct is properly transplanted into the wall of the stomach, it may remain patent for months. In animals in which this operative procedure has been carried out, the pancreas has been found to undergo no inflammatory or other degenerative changes. This finding is regarded as evidence against the postulation of Hlava that gastric juice is probably responsible for the occurrence of certain cases of acute hemorrhagic pancreatitis.
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Surgical Division of the Hunterian Laboratory of the Johns Hopkins University, Baltimore.