Twenty-four hour gastric acidity after vagotomy.

Abstract

SUMMARY Twenty-four hour intragastric pH during normal daily activity has been studied by nasogastric intubation and aspiration of gastric samples in seven patients four years after vagotomy (four truncal, three selective). Two of these patients also had pre-and early postoperative studies. Mean pH was inversely correlated with basal, insulin-and pentagastrin-stimulated acid outputs. However, one of four patients after truncal vagotomy with drainage, and two of three after selective vagotomy and drainage had most of their hourly intragastric pH values more acidic than pH 3*5 despite more than 70 % reductions in preoperative stimulated-acid outputs.Gastric surgeons do not know which aspect of gastric secretion they are trying to reduce when operating for peptic ulcer, because the aetiology of gastric and duodenal ulcer is not understood. There is a wealth of data on basal and stimulated acid outputs after gastric operations, but we know of only one pilot study (Baron, 1973) of their effects on intragastric acidity. We have, therefore, studied 24 hour intragastric pH during daily life in patients with duodenal ulcer disease before and after truncal or selective vagotomy and drainage. MethodsWe studied seven men with duodenal ulcer. Four patients had undergone truncal vagotomy and drainage and three selective vagotomy and drainage four years previously. Two of these patients (one truncal, one selective) also had an exactly similar study performed both before and two weeks after operation. They were all symptom free since their operation and at the time of this study. The subjects attended hospital at 0800 having had nothing to eat or drink since midnight. A small radio-opaque nasogastric tube (12-14 F.G. Rayx Porges Neoplex Levin, Porges, Paris, France) was passed and positioned fluoroscopically in the most dependent portion of the stomach. They were then admitted to a 'general ward for 24 hours where their activities regarding meals, fluids, bath, and toilet were as 'Present address:

Effects of a β2-Sympathomimetic on Histamine-stimulated Gastric Acid Secretion in Dogs

“…From experiments testing P-blocking agents, propranolol (a p,and p,-blocker), and practolol (predominantly a p,-blocker), it could be concluded that the sympathomimetic influence on gastric acid secretion involves @,-receptors. This is contrary to the findings of McCloy et al ( 17), who saw no effect of propranolol on histamine-induced gastric acid secretion.…”