The first essential, naturally, is to establish the fact that achlorhydria exists. The only reliable proof of this is supplied by fractional gastric analysis. A single extraction of stomach contents will not suffice. The gastric secretion must be watched throughout at least two hours after a test meal, for no free acid may be found at the end of forty-five minutes or one hour and yet may appear later on. No symptoms prove or disprove the existence of achlorhydria. Nothing in the physical examination alone determines the activity of the gastric secretion. Even roentgen-ray reports cannot be depended on to settle this question. Only fractional gastric analysis is conclusive.
Once it is determined that the stomach secretes no free hydrochloric acid, a starting point has been found from which to proceed to a diagnosis. We are then in a position to ask what conditions cause achlorhydria or with what diseases
CHENEY WF. THE SIGNIFICANCE OF ACHLORHYDRIA. JAMA. 1926;87(1):22–25. doi:10.1001/jama.1926.02680010022005
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