Effect of Vagotomy on Serum Gastrin in Patients with Duodenal Ulceration

Abstract

Summary The concept of increased vagal activity in patients with duodenal ulceration was investigated by observing the effect of medical and surgical vagotomy on the secretion of gastrin. Using a radioimmunoassay technique fasting serum levels of gastrin were determined in 41 normal subjects, 40 patients with duodenal ulceration and 16 patients following vagotomy. The effect of atropine on gastrin secretion was observed in a further 2 patients with duodenal ulceration. The patients with duodenal ulceration were found to have elevated serum levels of gastrin. The 8 patients with “complete” vagotomy had significantly lower serum levels of gastrin than the patients with duodenal ulceration, the patients with an “incomplete” vagotomy or the normal subjects. Post‐vagotomy hypergastrinaemia was associated with a recurrence of ulceration. The abolition, by medical or surgical vagotomy, of the hypergastrinaemia associated with duodenal ulceration is consistent with the hypothesis of an increased vagal tone in this disease. These studies also suggest that gastrin estimations may be useful in predicting the presence of inadequate vagotomies.

Serum gastrin in duodenal ulcer: Part III Influence of vagotomy and pylorectomy

“…His basal serum gastrin level was 52 pg/ml as compared with the group mean of 84 pg/ml but gastrin was still within the postvagotomy range. Byrnes, Lazarus, and Young (1970) are the only other group to have reported postvagotomy findings and their results are diametrically opposed to the present ones. That they are measuring a different gastrin or peptide is quite evident, and we believe that they may have found a component of 'gastrin' which is pathological, removed by complete vagotomy, and present in most patients with duodenal ulcer.…”

Effect of food on serum gastrin evaluated by radioimmunoassay

“…If this hypothesis is true, it would be expected that Byrnes would obtain less stimulation after giving atropine before food whereas we find augmentation of response to food. Further, Byrnes, Lazarus, and Young (1970c) find that atropine causes a fall in basal gastrin levels whereas the present study shows no change. These differences open up a most interesting vista as to the form in which gastrin is secreted in response to different stimuli and inhibitors.…”

Effect of proximal gastric vagotomy on gastric acid secretion and plasma gastrin

“…However, other workers have found that vagotomy produced marked changes in the fasting serum or plasma gastrin level. Byrnes et al (1970) noted that after complete truncal vagotomy there was, in eight patients, a reduction in the fasting serum gastrin to a level below that found in normals or in patients with duodenal ulcer. In contrast, Hansky and his coworkers found that vagotomy raised the fasting serum gastrin level from a mean of 15.7 ± 1.5 pg/ml in 72 unoperated duodenal ulcer patients (Korman, Soveny, and Hansky, 1971) to 52 ± 5.7 pg/ml in 30 patients following selective vagotomy and (usually) pyloroplasty (Korman et al 1972a).…”

“…It is difficult to account for these discrepancies between the findings of different workers. Perhaps the results of Byrnes et al (1970) may be explained by the fact that they used an antiserum raised against pentagastrin whereas all other workers have raised their antisera against gastrin heptadecapeptide. Plasma gastrin is known not to be a single molecular species (Yalow and Berson, 1970) and it seems likely that different antibodies detect different species of the hormone.…”

“…Little is known about the effect of vagotomy on the ability of the antrum to release gastrin. Some observations have been made on the effects of truncal vagotomy (Byrnes, Lazarus, and Young, 1970;Korman, Hansky, and Scott, 1972b;McGuigan and Trudeau, 1972) and selective vagotomy (Korman, Hansky, Coupland, and Cumberland, 1972a) but the results are conflicting. In previous studies a drainage procedure was an integral part of the operation.…”