PATHOPHYSIOLOGICAL SIGNIFICANCE OF ACHLORHYDRIA IN GASTRIC CARCINOMA

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Serum gastrin, gastric acid secretion, parietal cell mass and cyclic-AMP level of gastric mucosa were measured in a total of 50 patients with gastric carcinoma and 12 controls. The serum gastrin level of the patients appeared to be normal. The maximal gastric acid output was significantly lower in the patients than in the controls. The output was found to be independent of the stage of progression, size, site of growth or histological type of gastric carcinoma. The parietal cell mass was estimated to be 4.5×10⁶/cm² in the early stage of carcinoma and 4.0×10⁶/cm² in the advanced stage. There was no significant difference between them, but each value was markedly lower as compared with that of the control group (6.4×10⁶/cm²). In 8 of 33 cases, the maximal acid output did not relate to the parietal cell mass. Such cases showed a markedly lower cyclic-AMP level in the gastric mucosa of acid bearing area. This study supports the hypothesis that achlorhydria may predispose the development of carcinoma, and suggests that the resistance of parietal cells to gastrin is very important in the pathogenesis of achlorhydria as well as parietal cell diminution.