STUDIES ON PEPSIN AND ACID SECRETION FOLLOWING VARIOUS OPERATIONS FOR GASTRIC AND DUODENAL ULCER

Abstract

The present study was done in order to investigate the change of pepsin secretion following various operations for gastric and doudenal ulcer. Insulin-and histamine-stimulated pepsin secretion, in comparison with acid secretion, was studied in 140 cases with gastric and doudenal ulcer. Postoperative and follow-up studies were also made in 125 out of 140 cases. Pepsin secretion was expressed in terms of Peak pepsin output (PPO) as well as Peak acid output (PAO).
The results obtained are as follows:
Pepsin secretion in response to insulin and histamine was different from acid secretion in gastric and duodenal ulcer. In regard to pepsin secretion in response to stimulants, insulin was confirmed to be effectively stronger ability than histamine.
Concerning the various types of gastrectomies for gastric ulcer based upon pepsin secretion, pylorus-preseving gastrectomy and segmental gastrectomy are physiological operations, compared iwth Billroth I operation. After vagotomy with pyloroplasty and vagotomy with hemigastrectomy (Billroth I type) the reduction rates in PPO with insulin were 80 and 92% at follow-up, respectively. Similarly, PPO with histamine showed a reduction rate of 52 and 74%, respectively.
In the cases performed vagatomy with pyloroplasy when PPO with insulin is less than 100 tyrosine-mg/hr vagotomy may be considered as a"clinically adequate"operation.
Concerning the selection of vagotomy with pyloroplasty and vagotomy with hemigastrectomy for duodenal ulcer, the former is suggested for cases with a preoperative PPO less than 500 tyrosine-mg/hr, and the latter should be indicated for those with a value of between 500 and 1250 tyrosine-mg/hr, and the latter should be indicated for those with a value of between 500 and 1250 tyrosine-mg/hr. Further, partial gastrectomy such as Billroth I operation should preferably be empolyed if PPO is in excess of 1250 tyrosine-mg/hr.