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. 1974 Sep;15(9):714–719. doi: 10.1136/gut.15.9.714

Gastric acid secretion and risk of recurrence of duodenal ulcer within six to eight years after truncal vagotomy and drainage

O Kronborg
PMCID: PMC1413040  PMID: 4435586

Abstract

The value of insulin and augmented histamine tests in predicting recurrence of duodenal ulcer within six to eight years after truncal vagotomy and drainage was assessed in a series of 500 consecutively and electively operated patients. Criteria of recurrence were established by a discriminative analysis of gastric acid secretion parameters. Recurrence was predicted with a probability of about 75% in patients with dyspepsia, the proportion between recurrences and dyspeptic nonrecurrences being 1:1. The discriminatory ability of the insulin test was no better than that of the postoperative histamine test. Men with a preoperative PAO > 46·1 m-equiv/h had a risk of recurrence of 21%, women with a PAO > 41·5 m-equiv/h, 28%. Below these levels the risk was 5 and 1% respectively, demonstrating that recurrence after vagotomy is related to the number of parietal cells before vagotomy. A rationale is provided for antrectomy and vagotomy in duodenal ulcer patients with a high number of parietal cells.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. BRUCE J., CARD W. I., MARKS I. N., SIRCUS W. The rationale of selective surgery in the treatment of duodenal ulcer. J R Coll Surg Edinb. 1959 Jan;4(2):85–104. [PubMed] [Google Scholar]
  2. Baron J. H., Cowley D. J. Dose response of gastric acid to insulin in patients with incomplete vagotomy. Br J Surg. 1971 Apr;58(4):296–296. [PubMed] [Google Scholar]
  3. CLARK C. G., MURRAY J. G., SLESSOR I. M., WYLLIE J. H. COMPLETE VAGOTOMY AND ITS CONSEQUENCES: FOLLOW-UP OF 146 PATIENTS. Br Med J. 1964 Oct 10;2(5414):900–903. doi: 10.1136/bmj.2.5414.900. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Cowley D. J., Spencer J., Baron J. H. Acid secretion in relation to recurrence of duodenal ulcer after vagotomy and drainage. Br J Surg. 1973 Jul;60(7):517–522. doi: 10.1002/bjs.1800600705. [DOI] [PubMed] [Google Scholar]
  5. Dinstl K. Choice of operations for patients with duodenal ulcers. Surg Gynecol Obstet. 1969 Jan;128(1):77–80. [PubMed] [Google Scholar]
  6. GILLESPIE I. E., KAY A. W. Effect of medical and surgical vagotomy on the augmented histamine test in man. Br Med J. 1961 Jun 3;1(5239):1557–1560. doi: 10.1136/bmj.1.5239.1557. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. HIRSCHOWITZ B. I., O'LEARY D. K. DOSE DEPENDENCE OF INSULIN-STIMULATED GASTRIC SECRETION. Am J Dig Dis. 1964 Jun;9:379–397. doi: 10.1007/BF02239331. [DOI] [PubMed] [Google Scholar]
  8. Kronbarg O. Influence of the number of parietal cells on risk of recurrence after truncal vagotomy and drainage for duodenal ulcer. Scand J Gastroenterol. 1972;7(5):423–431. doi: 10.3109/00365527209180765. [DOI] [PubMed] [Google Scholar]
  9. Kronborg O. A follow-up of patients operated upon for recurrence after vagotomy and drainage for duodenal ulcer. Scand J Gastroenterol. 1973;8(2):123–128. [PubMed] [Google Scholar]
  10. Kronborg O. Methods and results of repeated insulin tests in patients with duodenal ulcer. Scand J Gastroenterol. 1970;5(7):577–583. [PubMed] [Google Scholar]
  11. Kronborg O., Pedersen T., Stadil F., Rehfeld J. F. The effect of beta-adrenergic blockade upon gastric acid secretion and gastrin secretion during hypoglycaemia before and after vagotomy. Scand J Gastroenterol. 1974;9(2):173–176. [PubMed] [Google Scholar]
  12. Kronborg O. The discriminatory ability of gastric acid secretion tests in the diagnosis of recurrence after truncal vagotomy and drainage for duodenal ulcer. Scand J Gastroenterol. 1973;8(6):483–489. [PubMed] [Google Scholar]
  13. Kronborg O. The stability of the insulin test result after truncal vagotomy and drainage for duodenal ulcer. Scand J Gastroenterol. 1971;6(7):637–644. doi: 10.3109/00365527109181146. [DOI] [PubMed] [Google Scholar]
  14. Kronborg O. The value of the insulin test in predicting recurrence after vagotomy and drainage for duodenal ulcer. Scand J Gastroenterol. 1971;6(5):471–478. doi: 10.3109/00365527109180728. [DOI] [PubMed] [Google Scholar]
  15. Kronborg O. Truncal vagotomy and drainage in 500 patients with duodenal ulcer. Scand J Gastroenterol. 1971;6(6):501–509. doi: 10.3109/00365527109181665. [DOI] [PubMed] [Google Scholar]
  16. Moore J. G. High gastric acid secretion after vagotomy and pyloroplasty in man--evidence for nonvagal mediation. Am J Dig Dis. 1973 Aug;18(8):661–669. doi: 10.1007/BF01072037. [DOI] [PubMed] [Google Scholar]
  17. Small W. P., Bruce J., Falconer C. W., Sircus W., Smith A. N. The results of a policy of selective surgical treatment of duodenal ulcer. Br J Surg. 1967 Oct;54(10):838–841. doi: 10.1002/bjs.1800541008. [DOI] [PubMed] [Google Scholar]
  18. Stadil F., Rehfeld J. F. Release of gastrin by epinephrine in man. Gastroenterology. 1973 Aug;65(2):210–215. [PubMed] [Google Scholar]
  19. Vecchio T. J. Predictive value of a single diagnostic test in unselected populations. N Engl J Med. 1966 May 26;274(21):1171–1173. doi: 10.1056/NEJM196605262742104. [DOI] [PubMed] [Google Scholar]
  20. Watkin D. F. The delayed insulin test and recurrent duodenal ulceration. Br J Surg. 1971 Oct;58(10):775–780. doi: 10.1002/bjs.1800581016. [DOI] [PubMed] [Google Scholar]

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