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Effects of Vagotomy on Gastric Acid Secretion

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Vagotomy

Abstract

Dragstedt, who introduced vagotomy as a routine surgical treatment for peptic ulcer, has several times summarized his clinical experience of vagotomy and his extensive studies on the physiology of gastric acid secretion. Dragstedt, basing his views on the discovery of the Pavlov school that the cephalic phase of gastric secretion is mediated over the vagi considers the main effects of vagotomy to be elimination of the interdigestive cephalic phase of gastric secretion and reduced sensitivity of the parietal cells to humoral stimuli (Dragstedt, 1969). Vagotomy markedly reduced interdigestive gastric secretion, determined as night secretion, in ulcer patients. The vagotomy was originally performed as a truncal vagotomy without a drainage operation; this resulted in a high frequency of postoperative gastric retention and in 5 to 10% in secondary gastric ulcers. These undesirable effects were eliminated by the addition of gastroenterostomy or pyloroplasty. Truncal vagotomy without a drainage operation produces secondary gastric ulcers with high frequency in the rabbit and the swine, but not in the dog and the rat. Dragstedt also found that the acid response in Heidenhain-pouch dogs after a meal increased following truncal vagotomy but did not increase following truncal vagotomy plus gastroenterostomy; he thought this indicated increased release of antral gastrin by gastric stasis following truncal vagotomy, although other mechanisms are conceivable. These findings underline the necessity for a drainage operation in combination with truncal vagotomy.

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References

  • Andersson S.: Gastric and duodenal mechanisms inhibiting gastric acid secretion. In: Handbook of Physiology. Section 6: Alimentary Canal. Vol.11. Secretion. Ed. W. Heidel. American Physiological. Society Washington D. C. 1967

    Google Scholar 

  • Andersson S. Nilsson G. Sjodin L. Uvnas B.: Mechanism of duodenal inhibition of gastric acid secretion. In: Nobel Symposium 16; Frontiers in Gastrointestinal Hormone Research. Ed. S. Andersson. Stockholm: Almquist & Wiksell 1973

    Google Scholar 

  • Andersson, S., Olbe, L.: Inhibition of gastric acid response to sham feeding in Pavlov pouch dogs by acidification of antrum. Acta physiol. scand. 61,55 (1964)

    Article  PubMed  CAS  Google Scholar 

  • Andersson, S., Grossman, M. I.: Effect of vagal denervation of pouches on gastric secretion in dogs with intact or resected antrums. Gastroenterology 48,449 (1965)

    PubMed  CAS  Google Scholar 

  • Amdrup, E., Jensen, H.-E.: Selective vagotomy of the parietal cell mass preserving innervation of the undrained antrum. Gastroenterology 59,522 (1970)

    PubMed  CAS  Google Scholar 

  • Amdrup, E., Kragelund, E., Humphrey, C. S., Smith, R. B., Goligher, J. C, Johnston, D.: Evidence for partial vagal reinnervation of the stomach after highly selective vagotomy without a drainage procedure (HSV) for duodenal ulcer in man. Gut 12,866 (1971)

    PubMed  CAS  Google Scholar 

  • Aubrey, D. A., Forrest, A. P. M.: The effect of vagotomy on human gastric secretion. Brit. J. Surg. 57,332 (1970)

    Article  PubMed  CAS  Google Scholar 

  • Bell, P. R. F.: The long-term effect of vagotomy on the maximal acid response to histamine in man. Gastroenterology 46,387 (1964)

    PubMed  CAS  Google Scholar 

  • Bergegardh, S., Olbe, L.: Gastric acid response to distension of the stomach in man. Acta physiol. scand. 82, 6 A (1971)

    Article  CAS  Google Scholar 

  • Berson, S. A., Yalwo R. S.: Nature of immunoreactive gastrin extracted from issues of gastrointestinal tract. Gastroenterology 60,215 (1971)

    PubMed  CAS  Google Scholar 

  • Broomé, A.: Mechanism of the vagotomy-induced suppression of the maximal acid response to histamine in antrectomized duodenal ulcer patients. Scand. J. Gastroent. 2,275 (1967)

    Article  Google Scholar 

  • Broomé, A., Olbe, L.: Studies on the mechanism of the antrectomy-induced suppression of the maximal acid response to histamine in duodenal ulcer patients. Scand. J. Gastroent. 4, 281 (1969)

    PubMed  Google Scholar 

  • Burstall, P. A., Schofield, B.: The effects of pyloric antrectomy on the secretory response of Heidenhain pouches in dogs to central vagal stimulation. J. Physiol. 123,168 (1954)

    PubMed  CAS  Google Scholar 

  • Clark, C. G., Lewin, M. R., Stagg, B. H., Wyllie, J. H.: Effect of proximal gastric vagotomy on gastric acid secretion and plasma gastrin. Gut 14,293 (1973)

    Article  PubMed  CAS  Google Scholar 

  • Clarke, R. J., Jaffe, B. M., Clendinnen, B. J., Williams, J. A.: Is a pyloroplasty necessary with proximal gastric vagotomy? Gut 13,842 (1972)

    Article  PubMed  CAS  Google Scholar 

  • Crean, G. P., Marshall, M. W., Rumsey, R. D. E.: Parietal cell hyperplasia induced by the administration of pentagastrin (ICI50,123) to rats. Gastroenterology 57,147 (1969)

    PubMed  CAS  Google Scholar 

  • Csendes, A., Walsh, J. H., Grossman, M. I.: Effects of atropine and of antral acidification on gastrin release and acid secretion in response to insulin and feeding in dogs. Gastroenterology 63,257 (1972)

    PubMed  CAS  Google Scholar 

  • Davison, J. S.: Response of single vagal afferent fibres to mechanical and chemical stimulation of the gastric and duodenal mucosa in cats. Quart. J. Exper. Physiol. 57,405 (1972)

    CAS  Google Scholar 

  • Dragstedt, L. R., Woodward, E. R., Camp, E. H.: The question of the return of gastric secretion after complete vagotomy. Arch. Surg. 61,775 (1950)

    Article  CAS  Google Scholar 

  • Dragstedt, II, L. R., Johnson, Jr, A. N., Singer, E. R., Oberhelman, Jr, H. A.: The effect of vagotomy on the intestinal phase of gastric secretion. Surg. Forum 11, 336 (1960)

    PubMed  Google Scholar 

  • Dragstedt, L. R.: Peptic ulcer. Amer. J. Surg. 117,143 (1969)

    Article  PubMed  CAS  Google Scholar 

  • Elder, J. B., Gillespie, G., Campbell, E. H. G., Gillespie, I. E., Crean, G. P., Kay, A. W.: The effect of vagotomy on the lower part of the acid dose-response curve to pentagastrin in man. Clin. Sci. 43,193 (1972)

    PubMed  CAS  Google Scholar 

  • Elder, J. B., Gillespie, G., Gillespie, I. E., Crean, G. P., Kay, A. W., Campbell, E. H. G.: The effect of sub-threshold doses of pentagastrin on the acid response to insulin in duodenal ulcer subjects before and after truncal vagotomy. Clin. Sci. 43,201 (1972)

    PubMed  CAS  Google Scholar 

  • Elwin, C.-E., Uvnäs, B.: Distribution and local release of gastrin. Gastrin (Ed. Grossman, M. I.), Univ. California Press, p. 69 (1966)

    Google Scholar 

  • EmÃ¥s, S., Grossman, M. I.: Effect of truncal vagotomy on acid and pepsin responses to histamine and gastrin in dogs. Amer. J. Physiol. 212,1007 (1967)

    PubMed  Google Scholar 

  • EmÃ¥s, S., Grossman, M. I.: Effect of truncal vagotomy on acid and pepsin responses to histamine and gastrin in cats. Amer. J. Physiol. 213,657 (1967)

    Google Scholar 

  • EmÃ¥s, S., Borg, I.: Acid response to pentagastrin and vagal stimulation in ulcer patients before and after selective vagotomy. 4th World Congr. Gastroent. Advance Abstr. p. 202 (1970)

    Google Scholar 

  • Fordtran, J. S., Walsh, J. H.: Gastric acid secretion rate and buffer content of the stomach after eating. J. Clin. Invest. 52,645 (1973)

    Article  PubMed  CAS  Google Scholar 

  • Feurle, G., Ketterer, H., Becker, H. D., Creutzfeldt, W.: Circadian serum gastrin concentrations in control persons and in patients with ulcer disease. Scand. J. Gastroent. 7,177 (1972)

    PubMed  CAS  Google Scholar 

  • Gelb, A. M., Baronofsky, I. D., Janowitz, H. D.: The effect of vagotomy and pyloroplasty on the maximal acid response to histamine. Gut 2,240 (1961)

    Article  PubMed  CAS  Google Scholar 

  • Grossman, M. I., Robertson, C. R., Ivy, A. C.: Proof of hormonal mechanism for gastric secretion; humoral transmission of distension stimulus. Amer. J. Physiol. 153,1 (1948)

    PubMed  CAS  Google Scholar 

  • Grossman, M. I.: Stimulation of secretion of acid by distention of denervated fundic pouches in dogs. Gastroenterology 41,385 (1961)

    PubMed  CAS  Google Scholar 

  • Grossman, M. I.: Secretion of acid and pepsin in response to distention of vagally innervated fundic gland area in dogs. Gastroenterology 42,718 (1962)

    PubMed  CAS  Google Scholar 

  • Hansky, J., Soveny, C, Korman, M. G.: Role of the vagus in insulin-mediated gastrin release. Gastroenterology 63,387 (1972)

    PubMed  CAS  Google Scholar 

  • Hodge, A. J., Masarei, J. R., Catchpole, B. N.: The role of the sympathetic nervous system in hypoglycaemia-stimulated gastric secretion. Gut. 13,341 (1972)

    Article  PubMed  CAS  Google Scholar 

  • Holle, F.: Spez. Magenchirurgie, Springer-Verlag 1968, pp. 448,500,509.

    Google Scholar 

  • Holle, F.: Die Entwicklung einer physiologischen Methode für die Ulkus-Chirurgie. Dtsch. med. Wschr. 97,779 (1972)

    Article  PubMed  CAS  Google Scholar 

  • Humphrey, C. S., Smith, R. B., Lyndon, P. J., Johnston, D.: Effect of truncal vagotomy, selective vagotomy and pyloroplasty, and highly selective vagotomy without drainage on the response to meat extract in man. Brit. J. Surg. 59,906 (1972)

    Article  PubMed  CAS  Google Scholar 

  • Johnston, D., Wilkinson, A. R.: Highly selective vagotomy without a drainage procedure in the treatment of duodenal ulcer. Brit. J. Surg. 57,289 (1970)

    Article  PubMed  CAS  Google Scholar 

  • Klempa, I., Holle, F., Bruckner, W., Welsch, K. H., Handle, H., Wolff, A.: The effect of selective proximal vagotomy and pyloroplasty on gastric secretion and motility in the dog. Arch. Surg. 103,713(1971)

    Article  PubMed  CAS  Google Scholar 

  • Knutson, TJ., Olbe, L.: Gastric acid response to sham feeding in duodenal ulcer patients before and after antrectomy. Acta physiol. scand. 82,33 A (1971)

    Article  CAS  Google Scholar 

  • Knutson, U., Olbe, L.: Gastric acid response to sham feeding in the duodenal ulcer patient. Scand. J. Gastroent. 8,513–522 (1973)

    PubMed  CAS  Google Scholar 

  • Konturek, S. J., Johnson, L. R.: Evidence for an enterogastric reflex for the inhibition of acid secretion. Gastroenterology 61,667 (1971)

    PubMed  CAS  Google Scholar 

  • Korman, M. G., Hansky, J., Coupland, G. A. E., Cumberland, V. H.: Serum gastrin in duodenal ulcer. Part IV. Effect of selective gastric vagotomy. Gut 13,163 (1972)

    Article  PubMed  CAS  Google Scholar 

  • Korman, M. G., Hansky, J., Coupland, G. A. E., Cumberland, V. H.: Serum gastrin response to insulin hypoglycaemia: studies after parietal cell vagotomy and after selective gastric vagotomy. Scand. J. Gastroent. 8,235 (1973)

    PubMed  CAS  Google Scholar 

  • Kronborg, O., Madsen, P.: A comparison of gastric acid secretions after highly selective vagotomy without drainage and selective vagotomy with a pyloroplasty. Scand. J. Gastroent. 7, 615(1972)

    Article  PubMed  CAS  Google Scholar 

  • Landor, J. H.: The effect of extragastric vagotomy on Heidenhain-pouch secretion in dogs. Amer. J. dig. Dis. 9,256 (1964)

    Article  PubMed  CAS  Google Scholar 

  • Liedberg, G.: Regulation of histidine decarboxylase activity in the gastric mucosa of the rat. Studentliteratur, Lund, Sweden. 1971

    Google Scholar 

  • Lyndon, P. J., Johnston, D.: The effect of fat in the duodenum on gastric secretion before and after truncal vagotomy and highly selective vagotomy in man. Brit. J. Surg. 59,905 (1972)

    PubMed  CAS  Google Scholar 

  • Martin, F., Macleod, I. B., Sircus, W.: Effects of antrectomy on the fundic mucosa of the rat. Gastroenterology 59,437 (1970)

    PubMed  CAS  Google Scholar 

  • Maung Pe Thein and Schofield, B.: Release of gastrin from the pyloric antrum following vagal stimulation by sham feeding in dogs. J. Physiol. 148,291 (1959)

    Google Scholar 

  • Middleton, M. D., Kelly, K. A., Nyhus, L. M., Harkins, H. N.: Selective vagal effects on the intestinal phase of gastric secretion. Gut 6,296 (1965)

    Article  PubMed  CAS  Google Scholar 

  • Moore, J. G., Englert, Jr, E.: Circadian rhythm of gastric acid secretion in man. Nature 226, 1261 (1970)

    Article  PubMed  CAS  Google Scholar 

  • Nilsson, G., Simon, J., Yalow, R. S., Berson, S. A.: Plasma gastrin and gastric acid responses to sham feeding and feeding in dogs. Gastroenterology 63,51 (1972)

    PubMed  CAS  Google Scholar 

  • Olbe, L.: Potentiation of sham feeding response in Pavlov-pouch dogs by subthreshold amounts of gastrin with and without acidification of denervated antrum. Acta physiol. scand. 61, 244 (1964)

    Article  PubMed  CAS  Google Scholar 

  • Olbe, L.: Effect of resection of gastrin-releasing regions on acid response to sham feeding and insulin hypoglycemia in Pavlov-pouch dogs. Acta physiol. scand. 62,169 (1964)

    Article  PubMed  CAS  Google Scholar 

  • Olbe, L.: Potentiation of acid sham feeding response in Pavlov-pouch dogs by histamine and by mesenteric-caval vein anastomosis. Acta physiol. scand. 66,473 (1966)

    Article  PubMed  CAS  Google Scholar 

  • Orloff, M. J., Abbott, A. G., Rosen, H.: Nature of the humoral agent responsible for portacaval shunt-related gastric hypersecretion in man. Amer. J. Surg. 120,237 (1970)

    Article  PubMed  CAS  Google Scholar 

  • Payne, R. A., Kay, A. W.: The effect of vagotomy on the maximal acid secretory response to histamine in man. Clin. Sci. 22, 373 (1962)

    PubMed  CAS  Google Scholar 

  • Pevsner, L., Grossman, M. I.: The mechanism of vagal stimulation of gastric acid secretion. Gastroenterology 28,493 (1955)

    PubMed  CAS  Google Scholar 

  • Preshaw, R. M.: Gastric acid output after sham feeding and during release or infusion of gastrin. Amer. J. Physiol. 219,1409 (1970)

    PubMed  CAS  Google Scholar 

  • Preshaw, R. M.: Inhibition of pentagastrin-stimulated gastric acid output by sham feeding. Fed. Proc. 32, (Abstr.) 410 (1973)

    Google Scholar 

  • Read, R. C, Thompson, B. W., Hall, W. H.: Conversion of Hollander tests in man from positive to negative. Arch. Surg. 104,573 (1972)

    Article  PubMed  CAS  Google Scholar 

  • Reed, J. D., Sanders, D. J.: Splanchnic nerve inhibition of gastric acid secretion and mucosal blood flow in anaesthetized cats. J. Physiol. 219,555 (1971)

    PubMed  CAS  Google Scholar 

  • Schofield, B.: Inhibition by acid of gastrin release. Gastrin (Ed. Grossman, M. I.), Univ. California Press, p. 171 (1966)

    Google Scholar 

  • Sircus, W.: The intestinal phase of gastric secretion. Quart. J. Exp. Physiol. 38,91 (1953)

    PubMed  CAS  Google Scholar 

  • Sjödin, L.: Potentiation of the gastric secretory response to sham feeding in dogs by infusions of gastrin and pentagastrin. Acta physiol. scand. 85,99 (1972)

    Article  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 62,912 (1972)

    PubMed  CAS  Google Scholar 

  • Stadil, F.: Effect of vagotomy on gastrin release during insulin hypoglycaemia in ulcer patients. Scand. J. Gastroent. 7,225 (1972)

    Article  PubMed  CAS  Google Scholar 

  • Stening, G. F., Grossman, M. I.: Gastric acid response to pentagastrin and histamine after extragastric vagotomy in dogs. Gastroenterology 59,364 (1970)

    PubMed  CAS  Google Scholar 

  • Stern, D. H., Walsh, J. H.: Gastrin release in postoperative ulcer patients: evidence for release of duodenal gastrin. Gastroenterology 64,363 (1973)

    PubMed  CAS  Google Scholar 

  • Straaten, T.: Die Bedeutung der Pylorusdrusenzone für die Magensaftsekretion. Arch. klin. Chir. 176,236(1933)

    Google Scholar 

  • Svensson, S.-E.: Secretory behaviour and histamine formation in the rat Heidenhain pouch following antrectomy. J. Physiol. 207,699 (1970)

    PubMed  CAS  Google Scholar 

  • Tepperman, B. L., Walsh, J. H., Preshaw, R. M.: Effect of antral denervation on gastrin release by sham feeding and insulin hypoglycemia in dogs. Gastroenterology 63,973 (1972)

    PubMed  CAS  Google Scholar 

  • Uvnäs, B.: The part played by the pyloric region in the cephalic phase of gastric secretion. Acta physiol. scand. 4, suppl. 13 (1942)

    Article  Google Scholar 

  • Walsh, J. H., Yalow, R. S., Berson, S. A.: The effect of atropine on plasma gastrin response to feeding. Gastroenterology 60,16 (1971)

    PubMed  CAS  Google Scholar 

  • Walsh, J. H., Csendes, A., Grossman, M. I.: Effect of truncal vagotomy on gastrin release and Heidenhain pouch acid secretion in response to feeding in dogs. Gastroenterology 63,593 (1972)

    PubMed  CAS  Google Scholar 

  • Willems, G.: Cell renewal in the gastric mucosa. Digestion 6,46 (1972)

    Article  PubMed  CAS  Google Scholar 

  • Woodward, E. R., Lyon, E. S., Landor, J., Dragstedt, L. R.: The physiology of the gastric antrum. Gastroenterology 27,766 (1954)

    PubMed  CAS  Google Scholar 

  • Yalow, R. S., Berson, S. A.: Further studies on the nature of immunoreactive gastrin in human plasma. Gastroenterology 60,203 (1971)

    PubMed  CAS  Google Scholar 

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Authors
  1. L. Olbe
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Editors and Affiliations

  1. Chirurg. Poliklinik der Universität, 8 München 2, Pettenkoferstr. 8a, Germany

    Fritz Holle (o. Professor der Chirurgie, F.A.C.S. gf. Direktor der Poliklinik der Universität München) (o. Professor der Chirurgie, F.A.C.S. gf. Direktor der Poliklinik der Universität München)

  2. Farmakoligska Institutione, Karolinska Institutet, S 10401, Stockholm 60, Sweden

    Sven Andersson M. D. (Dozent) (Dozent)

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Olbe, L. (1974). Effects of Vagotomy on Gastric Acid Secretion. In: Holle, F., Andersson, S. (eds) Vagotomy. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-65889-1_8

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  • DOI: https://doi.org/10.1007/978-3-642-65889-1_8

  • Publisher Name: Springer, Berlin, Heidelberg

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