Effect of Medical and Surgical Vagotomy on the Augmented Histamine Test in Man

Abstract

When the evolution of surgery in the treatment of duodenal ulcer is traced it is evident that during the last half-century surgeons have directed their efforts along two main channels. Firstly, search has been made for an operation which would cure the existing ulcer and guarantee prevention of recurrent ulceration; new procedures have been numerous and varied, but, after a brief vogue, most have been shown deficient in some respect. Secondly, and more recently, there have been well-planned clinical trials with accurate follow-up results on some of these procedures, in the hope that a particular single operation would be found to be so superior to others as to be suitable for all patients with duodenal ulcer. Partial gastrectomy, vagotomy with drainage, and antrectomy with vagotomy are well-tried and useful operations, but each carries a risk of recurrent ulceration and of other unpleasant side-effects. The quest for an ideal operation is now being relinquished in favour of a new objective-the selection of an operation or combination of operations which will most accurately meet the requirements of the individual case. The current studies are directed towards the identification of these requirements.Surgical vagotomy, which regularly reduces the basal secretion of gastric juice, the nocturnal secretion, insulinstimulated secretion, and histamine-induced secretion (0.5 mg. of histamine acid phosphate), has also been shown to cause a significant reduction in the maximal histamine secretion as judged by the augmented histamine test (Gillespie, Clark, Kay and Tankel, 1960). This test, preferred to the others on account of its ability to give reproducible results, is routinely used by us to measure the effect of surgical vagotomy on acid gastric secretion.More recently it has been shown that hexamethonium and atropine in combination (" medical vagotomy") is also capable of reducing the augmented histamine response and that a significant correlation exists between this reduction and the reduction due to subsequent surgical vagotomy (McArthur, Tankel, and Kay, 1960). The possible application of these findings to the selection of duodenal ulcer cases suited to vagotomy as surgical treatment was envisaged. In this paper we report the results of such a study. MethodsAll patients included in this study were males with proved duodenal ulcer who had been accepted for surgical treatment. They were selected only in so far B that elderly and poor-risk patients were excluded; treatment by gastro-jejunostomy was preferred in these circumstances. A total of 40 patients have been studied. Regardless of the results of the pre-operative acid tests, each was treated by vagotomy with gastro-jejunostomy.The vagal trunks were divided subdiaphragmatically after mobilization of the lower oesophagus, and a posterior gastrojejunostomy was made at the most dependent part of the stomach.Before operation each patient had two tests: the first was an augmented histamine test; in the second, the effect of medical vagotomy on the augmented histamin...

The Effect of Vagal Block or Hexamethonium on Gastric Secretion in the Dog

“…In the hope of finding a method for forecasting the result of vagotomy, hundreds of clinical tests have been made to study the blocking action of combinations of hexamethonium and atropine (McArthur et al 1960, Gillespie & Kay 1961, Johnston et al 1966. The theoretical basis of such tests has never been investigated.…”

Studies on gastrin: Part III Gastrin-like activity in stomachs of patients with peptic ulceration and gastric carcinoma

“…There was no definite evidence of inhibition of responses during the pre-operative 'insulin secretion tests' in patients with high total gastrin-like activity in their antra, as was observed in dogs with Heidenhain pouches responding to large doses of injected gastrin extracts (Gillespie and Grossman, 1963). The possible role of gastrin in the aetiology of duodenal ulceration has been suggested by Gillespie and Kay (1961) who showed that antrectomy alone led to healing of the duodenal ulcer in four patients. The Zollinger-Ellison syndrome provides an extreme example of possible effects of excessive gastrin (or gastrin-like substance) in circulation.…”

Oral β -stimulants can inhibit passive cutaneous anaphylaxis in rats through an indirect inhibitory mechanism: possible involvement of afferent and efferent nervous system via gastric β 2 -adrenoceptor stimulation

“…Reserpine at 1 mg/kg/time was intraperitoneally administered every other day, totally 5 times [10] and the animal was challenged with the antigen on the day 5 after the last administration. Hexamethonium at 50 mg/kg [11] was intraperitoneally administered 30 min and 6-OH-DA at 100 mg/kg [12] was intravenously administered 2 days before the antigen challenge.…”