Histamine- and insulin-stimulated gastric acid secretion after selective and truncal vagotomy.

Bank, Simmy; Marks, I. N.; Louw, J.H.

doi:10.1136/gut.8.1.36

Cited by 117 publications

(31 citation statements)

References 11 publications

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“…This test involves nasogastric intubation and an injection of insulin, both of which are unpleasant to the patient. Furthermore, interpretation of the results is difficult and controversial (Bachrach, 1962;Bank, Marks, and Louw, 1967). There is a real need for a simpler test which would be at least equally informative.…”

Section: Discussionmentioning

confidence: 99%

Supersensitivity and gastric emptying after vagotomy

Tinker¹,

Koçak²,

Jones³

et al. 1970

Gut

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Section: Discussionmentioning

confidence: 99%

Supersensitivity and gastric emptying after vagotomy

Tinker¹,

Koçak²,

Jones³

et al. 1970

Gut

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“…Many authors have suggested other criteria for defining a positive test, culminating in the multiple approach of Bank, Marks, and Louw (1967). They used five criteria, those of Hollander (1948), Waddell (1957), Bachrach (1962), Ross and Kay (1964), and one of their own, and scored one plus for each positive criterion.…”

mentioning

confidence: 99%

The predictive accuracy of the postvagotomy insulin test: A new interpretation.

Faber¹,

Russell²,

Parkin³

et al. 1975

Gut

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SUMMARY Insulin-stimulated gastric secretion alone, without reference to basal secretion, has been examined in 45 male patients with duodenal ulcer in whom no gastric operation had been performed and in 124 patients following vagotomy for duodenal ulcer. Gastric juice was examined in terms not only of conventional indices, observed volume, titratable acidity and acid output, but also VG, the volume corrected for pyloric loss and duodenal reflux.The range of secretion of the unoperated subjects was established in terms of peak and half-to two-hour values for all indices. By reference to these ranges, secretion of postvagotomy subjects could be divided into two groups: (a) those with secretion within the preoperative range, and (b) those with secretion less than the lower limit of the preoperative range.The best discrimination was given by VG; those within the preoperative range (peak VG in excess of 140 ml/hour and VG half to two hours in excess of 105 ml/hour) had a 50% liability to recurrent ulcer, while those below the preoperative range had a zero liability to recurrent ulcer. Of the conventional indices acid output gave the best discrimination, which was almost as good as VG. Peak acid output of 8 mmol/hour or acid output one half to two hours of 5 25 mmol/hour discriminated into two groups, with a 50% or zero liability to recurrent ulcer. Titratable acidity (Hollander's index of secretion), being highly susceptible to reflux, was not an adequate discriminant.Surgical division of the vagus nerves as a treatment for duodenal ulceration was reintroduced by Dragstedt and Owens in 1943. After reporting preliminary results on canine stomach pouches (Hollander, Jemerin, and Weinstein, 1942) Hollander (1946) described the use of the insulin test for detecting the presence of intact vagal fibres in patients following vagotomy. Two years later (Hollander, 1948) he modified his criteria and defined a positive test as one in which the free acidity in response to insulininduced hypoglycaemia was more than 20 mmol/ litre in excess of basal acidity. However he remained cautious with regard to these criteria saying, 'At no time have we stated that the test can predict the chances that the patient will be relieved of his ulcer or its symptoms, or that they will not recur at some future date'. After another two years' experience he 'Based on a paper read to the British

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“…Twenty units of soluble insulin administered intravenously was used as the stimulant (Hollander, 1946), and an assessment of completeness of vagotomy was made on multiple criteria (Bank, Marks, and Louw, 1967). Patients in clinical grades I and 11 (65 %) were regarded as having had a good result.…”

Section: Methodsmentioning

confidence: 99%