Effects of truncal, selective, and highly selective vagotomy on glucose tolerance and insulin secretion in patients with duodenal ulcer. Part I-Effect of vagotomy on response to oral glucose.

Humphrey, Christopher; Dykes, J. R. W.; Johnston, D.

doi:10.1136/bmj.2.5963.112

Cited by 36 publications

(14 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…While in this short-term study in rats after TV plus an adequate drainage operation we find no changes in weight gain, glucose and insulin, others have observed altered food intake, lower weight gain, higher fasting glucose, lower insulin and lower renal glucose threshold after prolonged observation periods [for details, see Woods and Porte, 1974]. This is in agreement with clinical communications in regard to fast ing glucose and insulin [Humphrey et al, 1975]. The reasons for these dif ferences are unknown, but may relate to differences in surgical and dietary preparation.…”

Section: Discussionsupporting

confidence: 79%

Basal Gastric Secretion, Mucosal Blood Flow and Associated Fasting Blood Hormones in the Rat

Hanisch¹,

Po²

1982

Eur Surg Res

View full text Add to dashboard Cite

After vagotomy (truncal, highly selective, superselective) in rats, basal gastric secretion, gastric mucosal blood flow, associated fasting blood glucose and a variety of hormones were measured. All forms of vagotomy reduce acid (volume, acidity, output), but highly selective and superselective – though not truncal – procedures stimulate basal pepsin secretion, whereas mucosal blood flow roughly parallels acid production. Spontaneous gastric mucosal lesions increase after highly selective vagotomy. Both highly selective and superselective – but not truncal – vagotomy tend to increase plasma glucose and somatostatin, while only the former reduces insulin and glucagon. Common to all vagotomies is the development of virtually undetectable calcitonin (<25 pg/ml) and of hypergastrinemia. It is concluded that in the rat with draining gastric fistula in response to vagotomy there are moderate differences in regard to gastric mucosal ulcer index, gastric secretion, glucose, glucose-regulating hormones, while lowered calcitonin may be a general feature of low vagal tone.

show abstract

Section: Discussionsupporting

confidence: 79%

Basal Gastric Secretion, Mucosal Blood Flow and Associated Fasting Blood Hormones in the Rat

Hanisch¹,

Po²

1982

Eur Surg Res

View full text Add to dashboard Cite

show abstract

“…The present study and the observation that the enteral insulin stimulation is well preserved in man after truncal vagotomy [21] suggest that the incretin effect probably is of humoral nature. The results concerning the enteral insulin stimulation in man are however, contradictory, in as much as Humphrey et al [22] recently found, that truncal vagotomy led to a diminished insulin response to oral glucose, whereas the insulin response to intravenously administered glucose was unchanged.…”

Section: Discussionmentioning

confidence: 90%

The enteral insulin-stimulation after pancreas transplantation in the pig

1976

View full text Add to dashboard Cite

Summary. The insulin responses to an oral glucose tolerance test (OGTT) and in intravenous glucose infusion (IVGI), designed to copy the changes in serum glucose concentrations found during OGTT, were measured in four pigs before and after heterotopic pancreatico-duodenal allotransplantation and total pancreatectomy. After transplantation and total pancreatectomy a remarkable hyperinsulinaemia occurred during OGTT and IVGI, reflected by an almost two-fold increment in the insulinogenic index after transplantation. This finding might be explained by drainage of the transplanted pancreas into the systemic circulation instead of the portal vein. The magnitude of the enteral stimulus, i. e. the incretin effect on insulin secretion during OGTT was unchanged after transplantation, suggesting that the incretin effect is not mediated by neural influences upon the endocrine pancreas.Key words: Glucose, incretin, insulin secretion, pancreatic transplantation, pigs.Oral glucose induces an insulin response more than twice as large as that induced by intravenous glucose [1][2][3][4]. The mechanism behind this phenomenon, termed incretin [5], has received much attention, but its nature has not yet been entirely explained. The incretin effect has mainly been conceived as being of hormonal nature [6][7][8][9][10][11]. However, it might also be due to neural augmentation of the insulin response [4,[12][13][14], though until now no studies have excluded this possibility.The present study was designed to evaluate the necessity of pancreatic innervation on the incretin effect in pigs by studying the effect of heterotopic pancreatic allotransplantation on the insulin responses to oral and intravenous glucose administration. Material and MethodsEight healthy pigs of Danish Landrace weighing 29-34 kg were used in the study.The operative procedure has been described in detail previously [15]. In short, total pancreaticoduodenectomy was performed in the donor pig, with resection of an 8 cm long segment of aorta containing both the coeliac and the superior mesenteric arteries. In the recipient pigs pancreaticoduodenal transplantation was as follows: The infrarenal vena cava and the abdominal aorta were exposed for approximately 8 cm. The distal end of the donor aortic segment was anastomosed end-to-side to the abdominal aorta of the recipient and the donor portal vein joined end-to-side to the inferior vena cava of the recipient. The duodenal segment was anastomosed end-to-side to the upper part of jejtmum. Total Pan7 createctomy was performed in the recipient pig one week after transplantation. Penicillin was given during the first postoperative week. Immunosuppressive therapy was not given.The mean survival time of the four pigs was 73.5 days (range 35-98 days). They remained normoglycaemic for an average of 63.3 days (range 21-91 days). During the investigative period all pigs were in good clinical condition without any signs of malabsorptive disorders. After death the pigs were autopsied and, to insure that there were no remaining pa...

show abstract

“…This regula tion seems to be impaired possibly due to vagotomy seen after TG [8][9][10][11][12][13][14][15], Galactose does not stimulate insulin se cretion [17]. Thus the blood galactose con centration in galactose test is determined by intestinal adsorption and liver elimination rates.…”

Section: Discussionmentioning

confidence: 99%

“…Vagotomy and 'chemical vagotomy' by atropine may impair the insu lin response to glucose [8][9][10][11][12], The patients after total gastrectomy may have a relative lack of insulin during postprandial hypergly cemia [ 13], and as a sign of long-term hyper glycemia elevated HbAI concentrations have been measured in dumping patients [14]. Results from intraoperative glucagon stimulated C peptide tests 10 min after the midline incision and 60-90 min later after the completion of gastric resection without truncal vagotomy or total gastrectomy with truncal vagotomy suggest that a truncal va gotomy will produce a significant inhibition of insulin secretion [15].…”

Section: Introductionmentioning

confidence: 99%

Postprandial Blood Concentrations of Insulin-Independent Carbohydrate, Galactose, in Oral Test after Gastric Surgery

Harju

Seppälä²,

Koivula³

et al. 1991

Eur Surg Res

View full text Add to dashboard Cite

In order to examine the postprandial blood concentrations of insulin-independent carbohydrates after gastric surgery oral galactose test (1.65 g/kg body weight in water, 33%, w/v) was performed in 55 symptomatic patients and in 5 healthy subjects. There were patients after total gastrectomy (TG) (n = 17), gastric resection with (GRS, n = 17) or without (GR; n = 12) selective vagotomy, and after proximal selective vagotomy (PSV, n = 9). The patients had immediately after drinking the test solution a 2- to 5-fold higher blood galactose concentration than the healthy subjects. The TG patients had the most rapid, the healthy subjects the slowest and the GR and GRS patients an intermediate rapid, immediate increase of blood galactose concentration. The TG patients showed a plateau 40–60 min and a decrease 60–90 min after the start of the test. The PSV patients showed a plateau 60–90 min after the commencement of the test. The GR and GRS patients and the healthy subjects had a continuous increase in blood galactose concentration during the whole test period, but the maximal point 90 min after the drinking of the solution was lower in the GRS than in the GR patients and lowest in the healthy subjects. The PSV patients had a lower blood galactose curve than the TG, GRS and GR patients but higher than the healthy subjects except the plateau 60–90 min postprandially. These results suggest that the postprandial blood concentration of insulin-independent carbohydrate, galactose, in symptomatic patients after gastric surgery relates with the type of operation and clearly deviates from healthy people.

show abstract

Effects of truncal, selective, and highly selective vagotomy on glucose tolerance and insulin secretion in patients with duodenal ulcer. Part I-Effect of vagotomy on response to oral glucose.

Cited by 36 publications

References 20 publications

Basal Gastric Secretion, Mucosal Blood Flow and Associated Fasting Blood Hormones in the Rat

Basal Gastric Secretion, Mucosal Blood Flow and Associated Fasting Blood Hormones in the Rat

The enteral insulin-stimulation after pancreas transplantation in the pig

Postprandial Blood Concentrations of Insulin-Independent Carbohydrate, Galactose, in Oral Test after Gastric Surgery

Contact Info

Product

Resources

About