Critical evaluation of the assessment of maximal gastric secretion stimulated by histamine

Royle, J P; Catchpole, B. N.

doi:10.1002/bjs.1800540114

Cited by 7 publications

(5 citation statements)

References 11 publications

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“…A continuous catgut suture, uniting serosa in front to serosa behind, is sometimes used to invert the raw lesser curvature in an effort to prevent regenerating nerve fibrils passing across from the lesser omentum into gastric muscle. fund' s to permii 'efficient gasiric aspiration when the patient lies Supine (Royle and Catchpole, 1967; on to the stomach about 4-7 cm. proximal to the pylorus, either Hector, 1968), the stomach around it is sutured carefdly to parietal peritoneum, any free blood is leaving the pyloric gland area innervated corpus, the second 2 cm.…”

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“…The first biopsy was obtained 5-7 cm. from the pylorus at the junctional zone between innervated ' antrum ' and denervated fund' s to permii 'efficient gasiric aspiration when the patient lies Supine (Royle and Catchpole, 1967; on to the stomach about 4-7 cm. proximal to the pylorus, either Hector, 1968), the stomach around it is sutured carefdly to parietal peritoneum, any free blood is leaving the pyloric gland area innervated corpus, the second 2 cm.…”

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Highly selective vagotomy without a drainage procedure in the treatment of duodenal ulcer

Johnston

Wilkinson

1970

Journal of British Surgery

296

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SUMMARYA consecutive series of 25 patients with chronic duodenal ulcer has been treated by highly selective vagotomy without a drainage procedure. The vagal fibres passing to the distal 5-7 cm. of the stomachthe nerves of Latarjet-were left intact, as were the hepatic and coeliac branches of the vagus. The object was to denervate only the parietal cell mass, while preserving normal gastric emptying and normal inhibition of gastric secretion from the antrum and duodenum. This operation should cure the ulcer as effectively as vagotomy with drainage does, and at lower cost in terms of side-effects such as dumping and diarrhoea.The insulin te,jt was negative in each case, suggesting that vagal denervation of the parietal cell mass was complete. Evidence provided by mucosal biopsies taken at operation does not fully support this view, however. Pentagastrin-stimulated acid output was reduced by 70 per cent, and pepsin output by 51 per cent, 3 months after operation. The volume of resting juice was halved and spontaneous acid output was reduced by 97 per cent at this time. Thus, highly selective vagotomy is as effective as truncal or bilateral selective vagotomy with drainage in reducing gastric acid output in the early months after operation.There have been no deaths. With 2 exceptions, the patients appear to be doing well clinically and few complain of side-effects, but the period of follow-up is only from 3 to 11 months.These results are encouraging. They suggest that a highly selective vagotomy, denervating the parietal cell mass but leaving the antrum innervated, may be all that is required to cure most patients who have a chronic duodenal ulcer.A CONSECUTIVE series of 25 patients with chronic duodenal ulcer has been treated by highly selective vagotomy without any form of drainage procedure. The vagotomy WBS confined to the acid-and pepsinsecreting area, the distal 5-7 cm. of the stomach being left innervated. This operation is thought to possess two specific advantages over truncal or bilateral selective vagotomy with drainage. First, gastric emptying should be almost normal and as a result dumping should be eliminated, because the antropyloroduodenal segment remains normal anatomically and its extrinsic vagal nerve-supply is kept intact. Secondly, the neurohumoral inhibitory mechanisms in the antrum and duodenum, which 'apply the brake' to gastric secretion, are preserved. Thus, postoperatively, inhibition is still lively, whereas maximal acid output is only 30 per cent of its former level. This should be enough to ensure that the ulcer heals and remains healed. Table I) who have been treated during the period February to October, 1969. I n each case the diagnosis of duodenal ulceration was made clinically, radiologically, and at operation. The series is consecutive, except that patients with pyloric stenosis and emergency cases were excluded. I n an attempt to detect patients with early pyloric stenosis, special attention was paid to symptoms such as vomiting, acid regurgitation, or heartburn, and to the natur...

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confidence: 99%

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confidence: 99%

Highly selective vagotomy without a drainage procedure in the treatment of duodenal ulcer

Johnston

Wilkinson

1970

Journal of British Surgery

296

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“…The vagotomy and pyloroplasty group had a lower mean loss (21.9 per cent) than any of the other groups (Billroth-I, 28.4 per cent; Polya, 29-2 per cent; vagotomy and gastroenterostomy, 30'7 per cent), but this difference was only significant when compared with the vagotomy and gastro-enterostomy group ( P < 0.05). Royle and Catchpole (1967) showed that significant losses could occur during gastric secretion tests, and Hobsley and Silen (1969) confirmed their findings. The importance of such losses during routine studies has not been investigated in detail.…”

Section: Effects Of Different Surgical Procedures Upon Loss-mentioning

confidence: 79%

An Assessment of the Value of Measuring Uncollected Gastric Secretion During Routine Secretion Studies in Man

1972

Journal of British Surgery

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A simple 'wash-out ' collection technique employing phenol red as a marker has been used during routine gastric secretion studies and its value has been assessed. Studies repeated on a single individual showed good reproducibility. When measured this way loss was not affected greatly by the volume secreted.With this technique the repeatability of pentagastrin tests has been assessed at intervals of 6 weeks. This demonstrated that both acid and pepsin outputs could vary considerably, with a mean variation in acid of over 26 per cent.The effects of histamine, pentagastrin, and insulin upon loss have been studied.Loss has been found to vary considerably from one study to another and from one patient to another and may on occasions be considerable, particularly after previous surgery.These findings suggest that a method of measuring loss should be adopted by any centre which wishes to use secretion studies to analyse the effects of treatment.THE value of secretion studies in clinical practice depends upon the accuracy with which they are performed. One possible source of inaccuracy is the failure to collect all the secretion produced, giving a falsely low calculated secretion. Surprisingly few workers have attempted to measure such losses so that the value of estimating the amount of secretion escaping collection has not been assessed fully.The present study was designed to establish a simple method of collection. Sophisticated techniques (such as the use of a radioactive marker) have been avoided and the method described relies upon changes in the concentration of phenol red (a nonabsorbable marker) between the time of instillation and withdrawal from the stomach. MATERIALS AND METHODSTechnique.-Prior to a test all medications were withheld for 24 hours and the subject was fasted for 12 hours.A double-lumen tube of special construction was used (Fig. I). One lumen ended 15 cm. proximal to the other and had two holes drilled near its end to produce a fine spray when phenol red was infused through it. Infusion was controlled by a peristaltic pump (Watson-Marlowe) at a rate between 10 and 15 ml. per minute. Phenol red was made up before a test by adding 20 ml. of stock solution (1.5 g. per litre) to 2 litres of distilled water. The second lumen FIG. I.-Diagrammatic representation of the collection technique.

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“…The errors of gastric secretion studies were listed by ROVL~ and CAa'CnPOLE [18], with a method for their reduction. This paper is the description of our methods for the reduction of these errors, together with the detailed description of a standard gastric secretion test.…”

Section: Discussionmentioning

confidence: 99%

A standardized technique for the performance of accurate gastric secretion studies

Whitfield

Hobsley

1979

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Critical evaluation of the assessment of maximal gastric secretion stimulated by histamine

Cited by 7 publications

References 11 publications

Highly selective vagotomy without a drainage procedure in the treatment of duodenal ulcer

Highly selective vagotomy without a drainage procedure in the treatment of duodenal ulcer

An Assessment of the Value of Measuring Uncollected Gastric Secretion During Routine Secretion Studies in Man

A standardized technique for the performance of accurate gastric secretion studies

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