The effect of vagotomy on the inhibition of gastric secretion by intraduodenal acid

Ward, A. S.

doi:10.1002/bjs.1800610906

Cited by 8 publications

(9 citation statements)

References 31 publications

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“…However, previous work in this laboratory has failed to establish any correlation between secretin release and gastric inhibition in subjects with intact vagi (Ward and Bloom, 1974). Moreover, the gastric inhibitory effects of duodenal acidification are abolished by all grades of vagal section (Ward, 1974), whereas secretin release clearly persists in this situation. The present evidence, taken in conjunction with this previous work, therefore supports the view that gastric secretory inhibition by intraduodenal acid is more closely dependent on a vagal reflex than on secretin release in man.…”

Section: Discussionmentioning

confidence: 81%

“…In view of the relatively small population size in each group, a non-parametric test (Wilcoxon's signed rank test) was also performed to confirm the significance of the difference between pre-and post-infusion values independently of the normality of the distribution. Changes in gastric acid output were assessed using methods previously described (Ward, 1974).…”

Section: Methods Of Assessing Responsementioning

confidence: 99%

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Effect of vagotomy on secretin release in man.

Ward¹,

Bloom²

1975

Gut

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SUMMARY The release of secretin by intraduodenal acid has been measured by means of a highly sensitive radioimmunoassay in 12 normal subjects, 23 duodenal ulcer patients, and 14 vagotomized patients (6 TV + P; 4 SV + P; 4 HSV). A highly significant response occurred in all three groups. There was no significant difference between the groups either in the magnitude or timing of this response, though the absolute values for pre-stimulation and peak secretin were significantly smaller in preoperative duodenal ulcer patients than in either the normal subjects or the vagotomized patients. The secretin response was similar after truncal, selective, and highly selective vagotomy. These results suggest that secretin release is not dependent on intact vagal innervation of the small intestine in man.Vagal influences are known to be important in the release of gastrin (Grossman, 1967), but whether the vagus is involved in secretin release has not been established. The secretin response to duodenal acid has recently been measured in man using a radioimmunoassay (Ward and Bloom, 1974) and in the present study this work has been extended to include an assessment of the post vagotomy response. Methods SUBJECTSTwelve normal subjects (10 males; two females), 23 duodenal ulcer patients (21 males; two females), and 14 vagotomized patients (12 males; two females) were investigated. The mean ages in the three groups were 38 years (21-63 years), 42 years (27-67 years), and 45 years (30-66 years). The mean weights were 71 kg (55-83 kg), 68 kg (52-82 kg), and 68 kg (48-79 kg) respectively. In the vagotomized group, tests were undertaken six months or more after truncal vagotomy and pyloroplasty (six), selective vagotomy and pyloroplasty (four), and highly selective vagotomy (four). All the patients were insulin negative at the time of testing according to Hollander's original criteria (Hollander, 1948), as well as the criteria of subsequent authors (Waddell, 1957;Bachrach, 1962;Ross and Kay, 1964;Bank et al., 1967).Intraduodenal acid may inhibit gastric secretion in addition to provoking secretin release (Johnston and Duthie, 1964) and the present results were Received for publication 10 October 1975. obtained during tests in which both phenomena were studied. Details regarding the changes in acid output are described more fully elsewhere (Ward, 1974).Gastric secretion was stimulated by a continuous intravenous infusion of pentagastrin (6 ,tg/kg/hour in normal subjects and preoperative ulcer patients, 9 ,ug/kg/hour in vagotomized patients) and 10 minute gastric collections were made throughout each test. Once a secretory plateau had been reached, which was usually by an hour, 40 ml 0.1 N hydrochloric acid, at 37°C, were infused into the distal duodenum over a five minute period. Gastric collection was then continued for a further hour. Secretin levels were monitored at intervals throughout each test. Blood was withdrawn from an antecubital vein into heparin-trasylol, then rapidly centrifuged and deep frozen. Samples were taken at 10...

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Section: Discussionmentioning

confidence: 81%

Section: Methods Of Assessing Responsementioning

confidence: 99%

Effect of vagotomy on secretin release in man.

Ward¹,

Bloom²

1975

Gut

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“…It is well known that vagally innervated receptors sensitive to acidity and osmolarity (Roze, Couturier, Chariot & Debray, 1977;Ward, 1974;Ward, 1976) are present in the proximal small intestine but their influence on the m.m.c. has yet to be investigated.…”

Section: Introductionmentioning

confidence: 99%

Initiation of migrating myoelectric complex in sheep by duodenal acidification and hyperosmolarity: role of vagus nerves.

Gregory¹,

Rayner²,

Wenham³

1984

The Journal of Physiology

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SUMMARY1. Gastrointestinal motility was studied in conscious sheep by X-radiography and by electromyography from chronically implanted electrodes before and after total thoracic vagotomy.2. Duodenal infusion of 0 5-3 mmol HCl (0*035-01 M-HCl) induced premature duodenal regular spiking activity (r.s.a.) within 1-7 min in fifteen of seventeen sheep studied when infused at 20 min after a natural r.s.a.3. There was no correlation between abomasal pH and any phase of the migrating 5. Vagotomy did not prevent the initiation or migration of the m.m.c., but reduced the rate of propagation of the r.s.a. from 40-5+7-2 (mean+S.E. of mean) to 16-7+0-1 cm/min in the duodenum, from 27-3+441 to 16-6+0 8 cm/min in the jejunum, and from 21 4 + 1 1 to 13-7 + 0 7 cm/min in the proximal ileum. Initially the frequency of r.s.a. increased, especially in the duodenum where they recurred at an interval of 98-4 + 6-8 min before vagotomy; and at 23-4 + 1P8 min in the first 24 h after vagotomy; the interval had lengthened to 86-7 + 5-2 min 2-3 weeks after vagotomy.6. Premature duodenal r.s.a. was not induced by duodenal infusion of HCl in five, or by duodenal infusion of hyperosmolar NaCl in three chronically vagotomized sheep.7. It is concluded that the vagus nerves contribute to the regulation of the frequency and propagation of the m.m.c. in sheep; duodenal acidification is not essential nor is it the normal stimulus for initiation of r.s.a., but duodenal infusion of HCl or hyperosmolar NaCl can initiate a premature duodenal r.s.a. via the vagus nerves.

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“…The main possibilities (which may of course interact) appear to be either a vagal reflex or a humoral response particularly involving secretin. The evidence for each of these views is fully discussed elsewhere (Ward, 1974). The role of the vagus has been examined in detail and it appears likely that gastric inhibition is dependent on a vagal reflex in man (Ward, 1974).…”

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The role of secretin in the inhibition of gastric secretion by intraduodenal acid

Ward¹,

Bloom²

1974

Gut

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SUMMARY The effect of intraduodenal acid on pentagastrin-stimulated gastric secretion has been investigated in 12 normal subjects and 23 patients with chronic duodenal ulceration. Plasma secretin levels were monitored during each test using a highly sensitive radioimmunoassay.Significant inhibition of gastric secretion occurred in the normal subjects and duodenal ulcer patients. A significant rise in plasma secretin was observed in both groups after intraduodenal acid though there was a complete lack of correlation between the magnitude of the secretin response and the degree of gastric inhibition. Ten subjects received intraduodenal acid and a subsequent intravenous infusion of exogenous secretin (0.125-0.25 units/kg over six minutes). Gastric inhibition occurred after the acid instillation but not after secretin infusion despite plasma secretin levels greatly in excess of those produced by intraduodenal acid.These results suggest that release of secretin by itself cannot explain the gastric inhibitory response to intraduodenal acid in man.The presence of acid in the duodenum is known to inhibit gastric secretion both in animals (Pincus, Friedman, Thomas, and Rehfuss, 1944;Sircus, 1958) and in man (Shay, Gershon-Cohen, and Fels, 1942;Johnston and Duthie, 1964). The mechanism of this response is, however, uncertain. The main possibilities (which may of course interact) appear to be either a vagal reflex or a humoral response particularly involving secretin. The evidence for each of these views is fully discussed elsewhere (Ward, 1974). The role of the vagus has been examined in detail and it appears likely that gastric inhibition is dependent on a vagal reflex in man (Ward, 1974). Strong claims, however, have been made that in dogs secretin is the mediator of gastric inhibition by intraduodenal acid (Johnson and Grossman, 1968) and the present study was therefore undertaken to examine the response with particular emphasis on the role of secretin. Materials and MethodsThe response to intraduodenal acid was investigated in 35 patients, 10 of whom also received an intravenous secretin infusion. There were 12 normal subjects (Orm, 2f) and 23 patients (21m, 2f) with chronic duodenal ulceration. The average age of Received for publication 10 July 1974. the normal subjects was 38 years (range 21-63) and their average weight 71 kg (range 55-83 kg). These subjects were awaiting minor inpatient surgery and all were free of gastrointestinal symptoms. The duodenal ulcer patients were awaiting gastric surgery and in all cases the pathology was confirmed subsequently at laparotomy. Their average age was 42 years (range 27-67) and their average weight 68 kg (range 52-82 kg).A duodenal inhibitory test (Ward, 1973) was carried out on each of the normal subjects and duodenal ulcer patients. The gastric stimulus was an intravenous infusion of pentagastrin at a dose rate of 6 ,g/kg/hr. Gastric samples were collected at 10-minute intervals throughout the test.Once a secretory plateau had been reached 40 ml of 0O1N hydrochloric acid ...

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The effect of vagotomy on the inhibition of gastric secretion by intraduodenal acid

Cited by 8 publications

References 31 publications

Effect of vagotomy on secretin release in man.

Effect of vagotomy on secretin release in man.

Initiation of migrating myoelectric complex in sheep by duodenal acidification and hyperosmolarity: role of vagus nerves.

The role of secretin in the inhibition of gastric secretion by intraduodenal acid

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