Conclusions
Until some “anti ulcer” medicament, hormone or biologic extract similar to Enterogastrone, Urogastrone or Anthelon is developed and made clinically applicable, the objective of treatment remains diminution of, or elimination of hydrochloric acid from the gastric content.
In Mann-Williamson dogs (where the acid secreting parietal cells are distributed throughout the entire gastric mucosa) stomal ulcer develops after “subtotal” gastrectomy, but does not do so after total (98%) gastrectomy (15).
In man (with the acid secreting cells usually limited to the proximal two-thirds of the stomach) removal of the alkaline secreting distal antrum is therefore unnecessary in an attempt to reduce hydrochloric secretion.
Because of the disadvantages of distal resection, and because of the “pari passu” improvement with more and more proximal resection (shift to the left) it may be that the fundal remnant after subtotal gastrectomy, is more “noxious” than an antral remnant.
Total fundusectomy (proximal partial gastrectomy) with removal of practically all (98%) of acid secreting fundus and body with anastomosis between the cardia and the alkaline secreting antrum would seem to be a logical physiologic improvement in the treatment of peptic ulcer and worthy of a clinical trial in surgical treatment of duodenal ulcer.
Removal of the secreting apparatus, the parietal cells, would permit a disregard of the various indirect (hormonal neural, cerebral, gastric or intestinal) stimuli to hydrochloric acid secretion,retain the advantages of the presently accepted “subtotal” gastrectomy (reduction of hydrochloric acid secretion) whileavoiding its disadvantages (stomal ulcer, the post-gastrectomy or “dumping” syndrome) that sometimes follow the unphysiologic gastrojejunal continuity and loss of alkaline secretion.
Possible objections are that the ulcer remains (removal may be unnecessary if the cause is removed) and pyloric obstruction, if functional will, of course, be corrected in pre-operative management; if organic, retention may be relieved by an associated pyloroplasty or gastro-duodenostomy.
Similar content being viewed by others
References
Dragstedt, L. R., et al Supra diaphragmatic section of the vagus nerve in treatment in duodenal ulcer and gastric ulcer. Gastroenterol 3 450, 1944.
Andrus, Lord and Stefko, Effects of pedicle grafts of jejunum in wall of stomach on gastric secretion. Ann. Surg. 118, 499, 1943.
Somervill, T. H., Physiologic gastrectomy. Brit. Jour. of Surg., Oct. 1945, 33 146.
Connell, F. G., Peptic Ulcer of the Jejunum, S. G. & O. June 1908, p. 39–43. Connell, F. G., Fundusectomy, S. G. & O., Nov. 1929, 696. Connell, F. G., Fundesectomy—experimental. S. G. & O., Dec. 1931, V. 53, p. 750. Connell, F. G., Resection of fundus of stomach for peptic ulcer. Ann. Surg., Aug. 1932, 200–203. Connell, F. G., Jejunal Ulcer. West Jour. Surg. Ob. & Gyn., Apr. 1933. Connell, F. G., Peptic Ulcer, Intractable and Recurrent. Trans. West. Surg. Assoc., 1938, p. 414. Connell, F. G., Partial fundusectomy (proximal gastrectomy): Review of 24 cases. Ann. Surg. Dec. 1943, V. 118, No. 6, 1000–1004. Connell, F. G., Editorial: Review of Gastroenterol. March 1948. Connell, F. G., Trends in diagnosis, etiology and treatment of duodenal ulcer. Amer. Jour. of Dig. Dis., V. 16, #2. Feb. 1949, p55–63.
Edkins, J. S., The chemical mechanism of gastric secretion. Amer. Jour. of Physiol. 34:133, 1906.
Connell, F. G., Peptic ulcer, hydrochloric acid and Edkins’ theory. Amer. Jour. of Surg., Aug. 1941, V. 57, #2, 255–259.
Kahlson, Geo., Brit. Med. Jour. 1948, 2-1091.
Ivy, A. C., Histamine and gastric secretion in relation to anti-histamine drugs. Gastroenterol., July 1948, V. 7, #1, 134.
Alvarez, Walter C., Personal communication.
Connell, F. G., Partial Gastrectomy in treatment of peptic ulcer. Surgery V. 3, #5, May 1938 p. 696–701.
Ivy, A. C., Personal communication, 6-29-49.
Fawcett, Blake, Personal communication, June 29, 1949.
Ricketts, Wm. E., Palmer, W. L., Hamman, Anna. Radiation therapy in peptic ulcer. Gastroenterol. V. 11, #6, Dec. 1948.
Kirsner, Jos. B., Levin, Erwin, and Palmer, Walter L., Observations on the excessive nocturnal gastric secretions in patients with duodenal ulcer. Gastroenterol. V. 11, #5, Nov. 1948.
Oliver, J. V., Arch of Surg., 55, 180, 1947.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Connell, F.G. The noxious antral remnant in treatment of peptic ulcer of the duodenum. Amer. Jour. Dig. Dis. 17, 296–298 (1950). https://doi.org/10.1007/BF03002546
Received:
Issue Date:
DOI: https://doi.org/10.1007/BF03002546