Effect of Pentagastrin After Vagotomy

Williamson, John; Hume, Robert; Weyers, Elspeth

doi:10.1016/s0140-6736(67)90257-7

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“…The results of the present study and those of the Multicentre do not support this conclusion, and this may be explained by the fact that subcutaneous and intravenous techniques are not strictly comparable. Williamson, Hume, and Weyers (1967), who studied the responses to histamine and pentagastrin given subcutaneously, found no significant difference between the mean peak acid outputs either preoperatively or postoperatively.…”

Section: Discussionmentioning

confidence: 97%

Continuous intravenous pentagastrin as a stimulant of maximal gastric acid secretion.

Mason¹,

Giles²,

Clark³

1969

Gut

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The synthetic gastrin-like pentapeptide (ICI 50, 123) may soon replace histamine as the standard stimulant of gastric secretion. As a diagnostic aid and for routine estimations a simple intramuscular test (Johnston and Jepson, 1967) may suffice. For research procedures, however, the rapid metabolism of the stimulant and the ability to produce a plateau of secretion give the intravenous infusion a considerable advantage. Difference of opinion exists as to the dose required to elicit a maximal response by this route (Konturek, 1967; Multicentre Studies, 1967; Wormsley, Mahoney, and Ng, 1966 341 ml aliquot from each was titrated against N/100 NaOH, using Topfer's reagent (end point approximately pH 3.5) as indicator. The results were recorded as milliequivalents of 'free' acid per 15-minute period.Using techniques identical with those described above an entirely different group of four female and 16 male patients were studied to compare the maximal acid secretion obtained with 0.4 ,ug/kg/hr of constant intravenous histamine acid phosphate, and 1-2 tg/kg/hr of similarly administered pentagastrin. All but four of the patients suffered from duodenal ulceration. The histamine test was covered by an intravenous injection of 50 mg mepyramine maleate (Anthisan) administered over a 10-minute period at the start of the histamine infusion, and was performed either on a different day, or at an interval of at least 45 minutes after the end of the pentagastrin infusion.Ten male volunteers were investigated who had previously undergone vagotomy and drainage for duodenal ulcer. Postoperative insulin testing (Hollander, 1946) had indicated complete vagal gastric denervation in all cases, and at least three months had elapsed since operation. These patients all received increasing doses of pentagastrin at levels of 3 0, 6-0, 12.0 ,ug/kg/hr in a manner similar to that described in the first group of patients. A histamine infusion test was performed 30 minutes after the conclusion of the pentagastrin infusion.In all cases the peak acid output has been derived by adding the results of the two highest consecutive 15-minute samples and doubling this value to express the result as milliequivalents of free acid per hour. Table I shows that in the seven cases where there was no interval between consecutive doses of pentagastrin the maximum gastric secretory response was achieved by a dose of 0-6 ,ug/kg/hr in one instance and by 1-2 ,ug/kg/hr in a further five. A dose of 6.0 ,g/kg/hr was required for patient K., but the response here was only marginally greater than that obtained by 0.6 ,ug/kg/hr. Of the eight cases in which there was an interval between the doses, four gave maximal values at 0.6 ,g/kg/hr, one at 1.2 ,ug/kg/hr, and the remaining three at 3.0 ,ug/kg/hr. However, it can be seen in many cases that the on 27 April 2019 by guest. Protected by copyright. RESULTS

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Section: Discussionmentioning

confidence: 97%