Test Meal

TEST MEAL is used to determine the secretory and motor functions of the stomach. The most common test meals are the Leube-Riegel, Bourget, and Kemp test meals. The test meal was proposed in order to establish the stomach's reaction under greater load, when determining the stomach's function with a trial breakfast is insufficient to assess the state of secretion and motor activity. The Leube-Riegel test meal (see Stomach, methods of stomach examination) is taken by the patient on an empty stomach at 12 noon. To determine secretion, stomach examination with a thick tube is performed after 3-4 hours. Normal figures for total acidity at this time are considered to be 70-100. The most favorable time for determining maximum secretion varies depending on the case; therefore, it is often necessary to repeat the examination and perform evacuation either earlier (after 2 hours) or later (after 5-6 hours). To determine motor ability, examination is performed after 7 hours followed by double washing of the stomach with ¹/2 liter of water. Normally, by that time the stomach is almost empty. If, however, after 7 hours the stomach contains significant residues, it is referred to as motor insufficiency of the 1st degree; if the stomach contains residues even after 12 hours of taking the test meal, it is motor insufficiency of the 2nd degree. Since repeated examinations are difficult, it is desirable to have an assessment of the secretory and motor functions of the stomach based on a single examination. For this purpose, examination is performed 4 hours after taking the test meal. The presence of a small residue indicates accelerated emptying, while a significant residue indicates delayed emptying. In the latter case, the examination should be repeated after 7 hours. The value of the Leube-Riegel test meal lies in the fact that its composition is most similar to daily food, and that already from a first glance at the obtained gastric contents, one can often assess the degree of digestibility of proteins and carbohydrates. Furthermore, due to the significant demands placed on the stomach by this test meal, it often allows for the best possible identification of the secretory and motor functions of the stomach. Acidity after the test meal in some cases is normal or even elevated, whereas after a trial breakfast it is found to be reduced. In some cases, with the help of the test meal, it is possible to detect mild disorders of the motor function of the stomach, whereas other methods (trial breakfast, X-ray) fail to detect these disorders. The Bourget test meal consists of 200 cc of broth, 100 g of beefsteak, 50 g of bread, and 100 g of cooked plums. Normally, the stomach is empty after such a meal in 3 hours. Kemp modified the Bourget test meal (see Stomach, methods of stomach examination). The time of emptying is 3-5 hours. If after 5 hours there is a significant residue in the stomach, it indicates a significant delay. To determine the duration of the delay, the examination is repeated on subsequent days and evacuation is performed after 6-8-10 hours. If only a 5-hour delay is determined, it is referred to as a mild disorder of motor ability. The use of test meals is limited due to several negative aspects of this methodology. Test meals are designed for long time intervals; not always well-digested pieces of meat, residues of plums, etc. can clog the tube opening and complicate the examination; determining acidity after the Leube-Riegel test meal is associated with many sources of error depending on the layered arrangement in the stomach of solid and liquid food, and acidity in different layers may vary; examination for hidden blood in gastric contents and stool is excluded due to the presence of meat in the composition of the test meal, and finally, patients, especially those with organic stomach diseases (cancer, ulcer, etc.), poorly tolerate the abundant and fatty food of the test meal.