The Effects on Gastrin and Gastric Secretion of Five Current Operations for Duodenal Ulcer

Abstract

We have measured serum gastrin and gastric acid secretion in 66 duodenal ulcer patients before and after vagotomy and pyloroplasty (V + P--15 patients), selective proximal vagotomy without drainage (SPV - D--11 patients), and with drainage (SPV + D--19 patients), and vagotomy, antrectomy, and either gastroduodenostomy (V + BI--15 patients) or gastrojejunostomy (V + BII--6 patients). Basal and peak postprandial gastrin levels were increased in postoperative V + P, SPV - D, and SPV + D patients. Basal and peak postprandial levels of gastrin were unchanged after V + BII, indicative of duodenal release of gastrin. Gastrin response to food was abolished in V + BII patients. Acid output was reliably reduced after all five operations; reduction was greatest in patients after antrectomy and least in patients after SPV. No beneficial results were found with drainage in SPV patients. Acid secretion increased with time in SPV patients, especially those with drainage.

Iron absorption in patients with Zollinger–Ellison syndrome treated with long‐term gastric acid antisecretory therapy

“… 62 , 64 , 65 Each of the three acid hyposecretory criteria used in the present study is more than 8‐fold less than the peak secretory values usually seen in a patient after gastric resection without ZES. The mean basal acid secretory rate after a Billroth II or Billroth I operation in patients without ZES in one study was 1.3 ± 1.0 mEq/h and 0.9 ± 0.3 mEq/h, 66 respectively, and in a second study after a partial gastrectomy were 0.83 and 1.9 mEq/h in patients with or without a post‐operative marginal ulcer 67 . These values are also significantly higher than the value of 0.2 mEq/h used as the most stringent criterion of hyposecretion in the present study.…”

The Present Status of Proximal Gastric Vagotomy

“…Proximal gastric vagotomy, as Thompson (1976) and other workers have shown, causes a fall in acid secretion and a rise in the serum gastrin response. The persistence of a significant basal acid secretion which increases with time, as noted by Jordan (1976a), together with the decrease i n the percentage of negative Hollander tests, from around 60% to 80% at one month, and down to 30% at 12 months, causes concern that the recurrence rate of ulcer may increase after proximal gastric vagotomy.…”

Effect of highly selective vagotomy on pancreatic exocrine function and on cholecystokinin and gastrin release.

“…By contrast, raised-gastrin levels were only a reflection of the increase in basal levels of gastrin, an established effect of truncal vagotomy. [36][37][38] Intragastric titration studies with control of luminal pH have shown that this post-vagotomy hypergastrinaemia cannot be explained entirely by loss of inhibition by endogenous HCI when acid secretion is reduced. 39 The increased cholecystokinin release noted in this study might be needed to achieve the same enzyme output from the pancreas, if reduced acid secretion after highly selective vagotomy diminished pancreatic sensitivity.…”