Augmented histamine test in the treatment of symptomatic hiatal hernia

Abstract

(Berman and Berman, 1959;Herrington, 1962). It is the purpose of this paper to indicate that these views have been fallacious and that in fact the pathology and symptoms bear no relation to the height of the basal or maximal acid output. MATERIALS AND METHODSThe augmented histamine test, as described by the Gastrointestinal Service of Groote Schuur Hospital (Marks, Bank, Moshal, and Louw, 1963) was performed in 150 unselected patients with symptomatic hiatal hernia. In this group there were 126 cases of sliding hiatal hernia, eight of composite hiatal hernia, and four of para-oesophageal hiatal hernia. Ninety-one were female and 47 were male patients. An additional 12 patients with sliding hiatal hernia had associated chronic duodenal ulcers. In this latter group were four females and eight males. The age range for the whole group was between 21 and 83 years.These were compared with control and duodenal ulcer groups from the Gastrointestinal Service consisting of 26 females and 35 males in the former group, and 290 females and 1,159 males in the latter group (Bank, Marks, Louw, and Bock, 1967). RESULTSThe basal gastric secretion in the hiatal hernia group is recorded in relation to those with and without heartburn (Fig. 1). A similar comparison is made with the maximal acid output. The hiatal hernias associated with duodenal ulcers were correlated in the same way (Fig. 2).In the hiatal hernia group with heartburn the mean basal output was 2-0 m-equiv/hr compared with 3.3 m-equiv/hr in the group without heartburn and 3 m-equiv/hr in the control group. There was no statistical significant difference in these figures.The mean maximal acid output in the group with 0 om 'U

The response of the lower oesophageal sphincter to maximal doses of pentagastrin

“…Levels of gastric acid secretion in patients with gastro-oesophageal reflux have been variably reported. Some workers have shown gastric hypersecretion (Herrington, 1962;Casten, 1967), while other workers have shown no difference from control subjects (Williams et a]., 1967;Silber, 1969). It is probable that high acid secretion in patients with gastro-oesophageal reflux will be found mainly in patients with an associated peptic ulcer.…”