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Gastro Lab: pH testing and more


GASTRIC STRING TEST
SSL used to do lots of these (2-3/wk) but not so often anymore
screening test for achlorhydria, frank hypochlorhydria (pH over 3) but does not reveal hidden hypochlorhydria
indications: suspected hypo or hyper chlorhydria, suspected gastric or esophageal bleed, pernicious anemia sx, IDA sx, unexplained GI sx, as dx aid for duodenal ulcer, thyroid dz, Addison's dz, agammaglobulinemia, vitiligo, all auto-immune disease, tender riddler's gastric acid point
timing of test: any time but best 30+ minutes after eating to see if re-acidification has occurred
after astric stimulation: after a strong cup of coffee or nodos--to see if anything stims acid
caffeine stimulates gastrin release, he says wait 30 mins not 3 hrs as in handout
if coffee doesn't work mb AI gastritis, need HCl replacement
(betaine HCl just replaces HCl, does not stim parietal cells)

PROCEDURE
ask about pt's gag reflex
before opening pkg, wash hands (capsules are single use)
pt may take a sip of water to moisten out and throat
pt swallows capsule with water while holding free end of floss outside mouth
floss unravels to stomach
may feel queasy for 10-30 seconds
lay supine for 5 minutes then one minute on each side (per SSL)
(handout) lies on L side for 10 minutes allowing maximal contact of floss with gastric pool
won't work without lying down
capsule dissolves after 7-10 minutes
have pt sit up
wear gloves to pull out to avoid blood, spreading H. pylori
have put look up to extend throat
pull string back out, continuous medium speed pull
have a bucket handy in case of gagging/vomiting
spread string on paper
measure pH on string with reagent stick
take lowest pH you find
red is lowest, pH of 1, then yellow, pea green is a 4, forest green is 6-7

ORDERING GASTRIC STRING TEST CAPSULES
smallest is 25 capsule in a box, cost is not cheap, from HDC
this test mostly used by drug companies
to test the efficacy of proton pump inhibitors
http://www.hdccorporation.com/
cant find pricing on site
HDC Diagnostics
142 N.Milpitas Blvd.
Milpitas, CA 95035
(not a shipping address. Please contact for shipping information)
866-645-9993
lross@hdccorp.com

HEIDELBERG TEST
SSL orders 5-6 of these/year
Heidelberg test you pull the capsule back out after an hour
opt for heidelberg when: ??, it can tell you what you need to do to correct pH

TITRATION
discover how much HCl to take; find your dose
inexpensive: take capsules of HCl and watch sx
ramp up dose gradually
pyrexia-->you have exceeded necessary dose
don't do with pts who have autonomic neuropathies (advanced DM)
pts feel better and sx go away
if pt needs 6-7 capules/meal-->prob have achlorhydria or severe hypo
take 3 and feel better-->you are hypo

SALIVARY PH
should be 7.5 so amylase can work, tooth enamel is protected
if severe reflux it could be very low, SSL had a pt with mouth pH of 2
pH paper, don't lick it, spit on it, because it has reagent on it
my salivary pH is 7.5, class range is 5.0-7.5 with several at 6.0
if very low, retest after an hour of not eating/drinking

HOW TO INCREASE MOUTH PH
if overgrowth of strep mutans: floss, brush
mouth rinse, gargle probiotics
treat reflux

ESOPHAGEAL TRANSIT TIME
swallow water and
listen with stethoscope to splash as it is delivered to stomach
should be 10 sec ish

LOWENBERG'S TEST
for neuromuscular excitability (in this class)
do you get cramps, twitches, or charley horses?
leg cramps?
indic: migraine, arrhythmias, m crap, abd cramp, twitch, tics, siezures
test w/ anything that makes you think Ca, Mg, K balance
procedure:
sit so leg hangs down
some say better if foot can touch floor (he did this)
has pt sit back and relax
cuff around gastroc
pump up to around 100
"will pump up a little at a time and you let me know when you feel you're about to get a cramp"
gives 1-2 secs to react with ea 10 pts pump
at 190 this pt said she felt it
now do other leg
cuff around gastroc
pumping 10 at a time
not comfortable but no going to cramp, went to 220
220 is ideal

now see if we can make more active side better
giving cal mag citrate powder (Thorne, also contains vit C) on tongue
not much, just so she can taste it
immediately retesting
she went 220 this time, no cramping
so she needs cal-mag supp
this supp helped SSL with his 3-4x weekly tension headaches

SUPP IDEAS FOR LOWENBERG'S
other neurolingual supps to try: any mineral combo supp
magnesium citrate
alka-calm
osteoprime
cal mag citrate powder
magnaleuvers (use this last)

LOWENBERG'S FROM WEB
for early diagnosis of thrombophlebitis, subjective reporting
before applying cuff, compare ankle extension side to side
this compares tone of gastrocnemius and soleus side to side
would have more tone if clot in progress

REPEATED MUSCLE CHALLENGE
for testing fatty acid nutrition
if you don't use same oil supp for all pts
find out whether or not they need lipid supp and what works for them
pt supine
arm straight up with palm lateral to test pec maj
test for 1-2 sec at 2 sec intervals and keep count
predictable, rhythmic
other hand on pt hip below asis
pt keep elbow straight
weakening at 17, failed at 19
should be able to do 20
do neurolingual testing for various oils
why does this work? EFAs essential for slow twitch muscle activity
what other slow twitch muscles could be used?

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