The effect of vagotomy and pyloroplasty on the maximal acid response to histamine

Gelb, Alvin M.; Baronofsky, Ivan D.; Janowitz, Henry D.

doi:10.1136/gut.2.3.240

Cited by 42 publications

(11 citation statements)

References 16 publications

(16 reference statements)

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“…The incidence, of such patients was reported to be 10 % by Gillespie and Kay (1961), 17% by Gelb, Baronofsky, and Janowitz, 1961), and 1 1 % by Sircus and Small (1964). The first of these workers indicated that complete vagotomy may not confer immunity frorn recurrent ulceration in all patients.…”

Section: Discussionmentioning

confidence: 99%

Propanthelene as an agent for medical vagotomy.

Checketts¹,

Gillespie²,

Kay³

1966

Gut

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EDITORIAL SYNOPSIS This well-designed, briefly and clearly presented study of the use of Probanthine as a blocking agent, in an attempt to predict the effect of surgical vagotomy on gastric acid responses, has produced potentially important results. Computer analysis has provided a formula with which to predict the post-operative responses more accurately than a comparison of absolute values.The aim of any operation for chronic duodenal ulcer is to reduce the amount of acid produced by the stomach, sufficiently to allow the ulcer to heal. Complete division of the vagi usually satisfies this criterion, but in some the reduction obtained, as measured by the augmented histamine test (Kay, 1953), may only be small (Sircus and Small, 1964). The patients in whom an adequate reduction is not obtained by vagotomy may be those who will develop further ulceration. It would obviously be an advantage if such individuals could be detected before operation. An attempt to do this was made by Gillespie and Kay (1961) using hexamethonium and atropine as medical vagotomy agents. Fairly good correlation was reported between the mean reductions of the pre-operative augmented histamine response by medical and surgical vagotomy. However, on an individual basis there was not always sufficient agreement between the two values to use the reduction achieved by medical vagotomy as a direct prediction of that achieved by surgical vagotomy. Furthermore, experience with these two agents has revealed a relatively high incidence of unpleasant side-effects, e.g., postural hypotension, blurring of vision, and delayed bladder emptying.In this study propanthelene bromide (Probanthine) was used as a medical vagotomy agent, and the results suggest that it may possess several advantages over hexamethonium and atropine. METHODSTwenty-five male patients with proven duodenal ulcers, who had been accepted for surgical treatment, were studied. Regardless of the pre-operative acid secretion studies, all were treated by sub-diaphragmatic vagotomy and a drainage procedure. Pyloroplasty was the treatment of choice, but in cases, 6, 9, 16, and 17 gastrojejunostomy was performed because of difficulties experienced in exposing the duodenum sufficiently for the former.In five patients the effect of Probanthine on the acid secretory response to insulin was studied. On the first day, after two 15-minute basal specimens had been collected, 20 units soluble insulin was given intravenously. On the second day, after the basal half-hour collection, Probanthine, 30 mg., was given intravenously at the same time as 20 units soluble insulin.A second group of 20 patients had an augmented histamine test on the first day and a similar test following medical vagotomy, as described below, on the second day. Post-operatively an insulin test for completeness of vagotomy was performed, followed the next day by a standard augmented histamine test.

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Section: Discussionmentioning

confidence: 99%

Propanthelene as an agent for medical vagotomy.

Checketts¹,

Gillespie²,

Kay³

1966

Gut

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“…No other factors which might contribute to the observed reduction in gastric acid output have been clearly identified. The associated drainage operation plays no part in producing the fall in acid secretion, since neither gastroenterostomy alone (Tankel, Gillespie, Clark, Kay, and McArthur, 1960) nor pyloroplasty alone (Gelb, Baronofsky, and Janowitz, 1961) significantly alter the maximal acid response. Thomson and Vane (1953) have shown that the secretory response to histamine can be correlated with gastric mucosal blood flow, but evidence is lacking that vagal section maintains impairment of mucosal vascular supply.…”

mentioning

confidence: 99%

Gastric mucosal structure and function after vagotomy

Melrose¹,

Russell²,

Dick³

1964

Gut

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“…The previous impression that complete vagotomy with a drainage procedure reduces the maximal histamine response by approximately 70 % (Gillespie, Clark, Kay, and Tankel, 1960;Gelb, Baronofsky, and Janowitz, 1961) is further confirmed by the mean reduction in augmented histamine response in those patients judged by all criteria to have negative responses to insulin. It is therefore believed that lesser degrees of reduction in the augmented histamine response may well be associated with incomplete vagal section.…”

Section: Discussionmentioning

confidence: 77%