Abstract
Insulin-stimulated gastric secretion alone, without reference to basal secretion, has been examined in 45 male patients with duodenal ulcer in whom no gastric operation had been performed and in 124 patients following vagotomy for duodenal ulcer. Gastric juice was examined in terms not only of conventional indices, observed volume, titratable acidity and acid output, but also Vg, the volume corrected for pyloric loss and duodenal reflux. The range of secretion of the unoperated subjects was established in terms of peak and half-totwo-hour values for all indices. By reference to these ranges, secretion of postvagotomy subjects could be divided into two groups: (a) those with secretion within the preperative range, and (b) those with secretion less than the lower limit of the preoperative range. The best discrimination was given by Vg; those within the preoperative range (peak Vg in excess of 140 ml/hour and Vg half to two hours in excess of 105 ml/hour) had a 50% liability to recurrent ulcer, while those below the preoperative range had a zero liability to recurrent ulcer. Of the conventional indices acid output gave the best discrimination, which was almost as good as Vg. Peak acid output of 8 mmol/hour or acid output one half to two hours of 525 mmol/hour discriminated into two groups, with a 50% or zero liability to recurrent ulcer. Titratable acidity (Hollander's index of secretion), being highly susceptible to reflux, was not an adequate discriminant.
Full text
PDF





Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- BACHRACH W. H. Laboratory criteria for the completeness of vagotomy. Am J Dig Dis. 1962 Dec;7:1071–1085. doi: 10.1007/BF02232984. [DOI] [PubMed] [Google Scholar]
- BARON J. H. Studies of basal and peak acid output with an augmented histamine test. Gut. 1963 Jun;4:136–144. doi: 10.1136/gut.4.2.136. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Bank S., Marks I. N., Louw J. H. Histamine- and insulin-stimulated gastric acid secretion after selective and truncal vagotomy. Gut. 1967 Feb;8(1):36–41. doi: 10.1136/gut.8.1.36. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Faber R. G., Russell R. C., Royston C. M., Whitfield P., Hobsley M. Duodenal reflux during insulin-stimulated secretion. Gut. 1974 Nov;15(11):880–884. doi: 10.1136/gut.15.11.880. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Gillespie G., Elder J. B., Smith I. S., Kennedy F., Gillespie I. E., Kay A. W., Campbell E. H. Analysis of basal acid secretion and its relation to the insulin response in normal and duodenal ulcer subjects. New criterion for the insulin test. Gastroenterology. 1972 May;62(5):903–911. [PubMed] [Google Scholar]
- HIRSCHOWITZ B. I. Electrolytes in human gastric secretion. Observations and a theory. Am J Dig Dis. 1961 Mar;6:199–228. doi: 10.1007/BF02283955. [DOI] [PubMed] [Google Scholar]
- Hassan M. A., Hobsley M. Positioning of subject and of nasogastric tube during a gastric secretion study. Br Med J. 1970 Feb 21;1(5694):458–460. doi: 10.1136/bmj.1.5694.458. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Hobsley M. Pyloric reflux: a modification of the two-component hypothesis of gastric secretion. Clin Sci Mol Med. 1974 Aug;47(2):131–141. doi: 10.1042/cs0470131. [DOI] [PubMed] [Google Scholar]
- Hobsley M., Silen W. Use of an inert marker (phenol red) to improve accuracy in gastric secretion studies. Gut. 1969 Oct;10(10):787–795. doi: 10.1136/gut.10.10.787. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Kronborg O. Dose dependence of insulin-activated gastric acid secretion in patients with duodenal ulcer before and after vagotomy. Scand J Gastroenterol. 1971;6(1):33–38. doi: 10.3109/00365527109180666. [DOI] [PubMed] [Google Scholar]
- ROSS B., KAY A. W. THE INSULIN TEST AFTER VAGOTOMY. Gastroenterology. 1964 Apr;46:379–386. [PubMed] [Google Scholar]
- SUN D. C., SHAY H. Mechanism of action of insulin hypoglycemia on gastric secretion in man. J Appl Physiol. 1960 Jul;15:697–703. doi: 10.1152/jappl.1960.15.4.697. [DOI] [PubMed] [Google Scholar]
- Smith I. S., Gillespie G., Elder J. B., Gillespie I. E., Kay A. W. Time of conversion of insulin response after vagotomy. Gastroenterology. 1972 May;62(5):912–917. [PubMed] [Google Scholar]
- Thomson J. P., Russell R. C., Hobsley M. Double-lumen tube for gastric secretion studies. Br Med J. 1973 Jul 21;3(5872):175–175. doi: 10.1136/bmj.3.5872.175-a. [DOI] [PMC free article] [PubMed] [Google Scholar]
- WADDELL W. R. The acid secretory response to histamine and insulin hypoglycemia after various operations on the stomach. Surgery. 1957 Oct;42(4):652–658. [PubMed] [Google Scholar]
- WEINSTEIN V. A., HOLLANDER F. Correlation of insulin test studies and clinical results in a series of peptic ulcer cases treated by vagotomy. Gastroenterology. 1950 Feb;14(2):214-27; Disc, 235. [PubMed] [Google Scholar]