The inhibitory effect of secretin on broth-stimulated gastric secretion in human subjects

Kamionkowski, Mario D.; Grossman, Seymour; Fleshler, Bertram

doi:10.1136/gut.5.3.237

Cited by 19 publications

(4 citation statements)

References 8 publications

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“…Larger doses of secretin given in one minute or so might have produced inhibition, but such massive stimulation would almost certainly have greatly exceeded any physiological stimulus. The failure of secretin in our study to inhibit histamine-stimulated gastric secretion is in accord with previous work in the dog (Gillespie and Grossman, 1964;Greenlee, Longhi, Guerrero, Nelsen, El-Bedri, and Dragstedt, 1957) although, in man, gastric secretion elicited by broth was inhibited by secretin (Kamionkowski et al, 1964). In a recent paper, however, Wormsley and Grossman (1964) showed that secretin inhibited histamine-stimulated gastric secretion from the vagally innervated main stomach of the dog, but did not inhibit the secretion from a Heidenhain pouch: yet acid in the duodenum could inhibit Heidenhain pouch secretion, whence these workers inferred that 'release of secretin was not the sole inhibitory mechanism elicited by endogenous acid in the duodenum'.…”

Section: Effect Of Gastrointestinal Hormonal Substancessupporting

confidence: 92%

“…The evidence from experiments on dogs has been conflicting, Code and Watkinson (1955) and Code (1963), and Sircus (1958) favouring the 'nervous' theory, while Andersson (1960a and b) has suggested a humoral basis because he was able to demonstrate some inhibition of secretion in denervated pouches. In man, secretin given intravenously has been shown to inhibit gastric secretion stimulated by broth (Kamionkowski, Grossman, and Fleschler, 1964) but there is no evidence about the mechanism of duodenal inhibition of histaminestimulated gastric secretion. This paper presents the results of an investigation in this field which lead us to believe that a hormonal substance is partly responsible for the inhibition.…”

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confidence: 99%

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Inhibition of histamine-stimulated gastric secretion by acid in the duodenum in man.

Johnston¹,

Duthie²

1966

Gut

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Section: Effect Of Gastrointestinal Hormonal Substancessupporting

confidence: 92%

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confidence: 99%

Inhibition of histamine-stimulated gastric secretion by acid in the duodenum in man.

Johnston¹,

Duthie²

1966

Gut

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“…For example, this region is the site of the physiological 'brake' on gastric motility (Thomas, 1957) and secretion in man (Griffiths, 1936;Shay, Gershon-Cohen, and Fels, 1942;Gillespie, 1959;Ksster and Rune, 1963;Johnston and Duthie, 1964, 1969. The secretory inhibition probably has both a nervous component (Code and Watkinson, 1955 ;Iggo, 1957;Sircus, 1958;Duthie, 1966, 1969) and a humoral component (Woodward, Lyon, Landor, and Dragstedt, 1954;Greenlee, Longhi, Guerrero, Nelsen, El-Bedri, and Dragstedt, 1957 ;Andersson, 1960Andersson, , 1963Andersson, , 1969Kamionkowski, Grossman, and Fleschler, 1964;Wormsley and Grossman, 1964;Johnston and Duthie, 1966). Inhibition of motility is also neurohumoral in nature (Thomas, 1957).…”

Section: Discussionmentioning

confidence: 99%

Highly selective vagotomy without a drainage procedure in the treatment of duodenal ulcer

Johnston

Wilkinson

1970

Journal of British Surgery

296

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SUMMARYA consecutive series of 25 patients with chronic duodenal ulcer has been treated by highly selective vagotomy without a drainage procedure. The vagal fibres passing to the distal 5-7 cm. of the stomachthe nerves of Latarjet-were left intact, as were the hepatic and coeliac branches of the vagus. The object was to denervate only the parietal cell mass, while preserving normal gastric emptying and normal inhibition of gastric secretion from the antrum and duodenum. This operation should cure the ulcer as effectively as vagotomy with drainage does, and at lower cost in terms of side-effects such as dumping and diarrhoea.The insulin te,jt was negative in each case, suggesting that vagal denervation of the parietal cell mass was complete. Evidence provided by mucosal biopsies taken at operation does not fully support this view, however. Pentagastrin-stimulated acid output was reduced by 70 per cent, and pepsin output by 51 per cent, 3 months after operation. The volume of resting juice was halved and spontaneous acid output was reduced by 97 per cent at this time. Thus, highly selective vagotomy is as effective as truncal or bilateral selective vagotomy with drainage in reducing gastric acid output in the early months after operation.There have been no deaths. With 2 exceptions, the patients appear to be doing well clinically and few complain of side-effects, but the period of follow-up is only from 3 to 11 months.These results are encouraging. They suggest that a highly selective vagotomy, denervating the parietal cell mass but leaving the antrum innervated, may be all that is required to cure most patients who have a chronic duodenal ulcer.A CONSECUTIVE series of 25 patients with chronic duodenal ulcer has been treated by highly selective vagotomy without any form of drainage procedure. The vagotomy WBS confined to the acid-and pepsinsecreting area, the distal 5-7 cm. of the stomach being left innervated. This operation is thought to possess two specific advantages over truncal or bilateral selective vagotomy with drainage. First, gastric emptying should be almost normal and as a result dumping should be eliminated, because the antropyloroduodenal segment remains normal anatomically and its extrinsic vagal nerve-supply is kept intact. Secondly, the neurohumoral inhibitory mechanisms in the antrum and duodenum, which 'apply the brake' to gastric secretion, are preserved. Thus, postoperatively, inhibition is still lively, whereas maximal acid output is only 30 per cent of its former level. This should be enough to ensure that the ulcer heals and remains healed. Table I) who have been treated during the period February to October, 1969. I n each case the diagnosis of duodenal ulceration was made clinically, radiologically, and at operation. The series is consecutive, except that patients with pyloric stenosis and emergency cases were excluded. I n an attempt to detect patients with early pyloric stenosis, special attention was paid to symptoms such as vomiting, acid regurgitation, or heartburn, and to the natur...

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“…There were no significant differences between the releases of gastrin after the two test meals. gastrin release; protein mealProtein, a mixture of amino acids, meat extract, and liver extract are known to cause release of gastrin (Kamionkowski et al 1964; Korman et al 1971;Wyllie et al 1972;Walsh and Grossman 1975). reported that a mixture of amino acids produced a peak gastrin response that was approxi mately 60% of that produced by a meat meal.…”

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Gastrin response to protein test meal in gastric diseases.

Inoue

Nakagawa

1980

Tohoku J. Exp. Med.

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The serum gastrin responses after ingestion of hard boiled eggs and Nutrient Broth solution were examined in peptic ulcer patients and normal subjects.The values observed of the serum gastrin response to these test meals were compared and contrasted. A significant enhancement of gastrin release in response to protein was obtained. There were no significant differences between the releases of gastrin after the two test meals. gastrin release; protein mealProtein, a mixture of amino acids, meat extract, and liver extract are known to cause release of gastrin (Kamionkowski et al. 1964; Korman et al. 1971;Wyllie et al. 1972;Walsh and Grossman 1975). reported that a mixture of amino acids produced a peak gastrin response that was approxi mately 60% of that produced by a meat meal. Therefore, liver extract, meat extract and various kinds of meals are often used for testing gastrin release. In this respect, Blair et al. (1975) reported that there were no significant differences in the peak gastrin response after meals varying in composition. In order to standardize the feeding test used to assess the gastrin response, protein feeding tests were employed.The mechanisms of the gastrin-releasing action of peptide and amino acids of these test meals have not been fully elucidated. Several possibilities of release of gastrin by protein in the stomach are : 1) direct action on the G cell, 2) action through the nervous intermediation, 3) autoregulation of gastrin release by changing the intragastric pH, 4) stimulation by antral distention, and 5) a combination of these mechanisms. The role of antral alkalinization for gastrin release has been discussed, but it is admitted that alkalinization alone does not regularly increase serum gastrin. There is little evidence for an effect of alkali on serum gastrin. (McGuigan and Trudeau 1970;Feurle 1975) In this study, the serum gastrin responses after ingestion of hard boiled eggs and 0.8% Nutrient Broth solution were performed in the same subjects on different days.

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The inhibitory effect of secretin on broth-stimulated gastric secretion in human subjects

Cited by 19 publications

References 8 publications

Inhibition of histamine-stimulated gastric secretion by acid in the duodenum in man.

Inhibition of histamine-stimulated gastric secretion by acid in the duodenum in man.

Highly selective vagotomy without a drainage procedure in the treatment of duodenal ulcer

Gastrin response to protein test meal in gastric diseases.

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