Studies on the Etiologic Factors of Peptic Ulcer With Special Reference to Gastric Acidity Following Functional and Circulatory Impairment of the Liver

Abstract

With the purpose of studying the pathogenesis of peptic ulcer complicating liver cirrhosis, clinical and experimental investigation was done on gastric acid secretion. The effects of such surgical procedures as portacaval anastomosis and proximal gastrectomy on gastric acid secretion were studied on clinical materials. Gastric acid secretion was also studied experimentally in dogs with carbon tetrachloride poisoning and dogs with altered condition of hepatic circulation.
These revealed;
1) The response of gastric acid secretion to histamine was doubled and prolonged following portacafal anastomosis in normal dogs.
2) These effects of portacaval anastomosis on gastric acid secretion were more pronounced when performed on dogs with carbon tetrachloride poisoning.
3) A 50%-increase in mean maximal gastric acidity was observed in dogs with carbon tetrachloride poisoning as well as dogs with hepatic vein constriction.
4) The histamine-stimulated gastric acid secretion augumented by portacaval anastomosis, carbon tetrachloride poisoning, or both was decreased by vagotomy added to them.
5) Following portacaval anastomosis, non-cirrhotic patients with intrahepatic portal obstruction developed a definite hyperacidity; the mean maximal acidity reaching as high as 90mEq/l. More prnounced augumentation of gastric acid secretion was observed when a portacaval anastomosis was performed on cirrhotics.
6) Following proximal gastrectomy combined with vagotomy and pyloroplasty, the gastric acid secretion was decreased by 30-59%, suggesting a lowered ulcerative diathesis.
These findings would suggest that vagotomy and pyloroplasty have to be added to shunt operations, if the ocurrence of peptic ulceration is to be avoided, while proximal gastrectomy is secure in this regard.