Serum gastrin in duodenal ulcer Part IV Effect of selective gastric vagotomy

SUMMARY Serum gastrin has been measured in 30 patients following selective gastric vagotomy. Basal serum gastrin was 52+5.7 pg/ml which was significantly lower than the corresponding level in 50 patients following truncal vagotomy (84+7.9 pg/ml). After a standard protein meal serum gastrin rose to 136±8.3 pg/ml at 60 minutes after the meal. The peak rise above basal levels was significantly lower than that achieved in patients who had undergone truncal vagotomy. These results complement our previous hypothesis that section of extragastric vagal fibres permits the release of additional gastrin above that expected with the diminution of acid secretion, and hence the decrease in inhibition of gastrin release from the antrum. Korman, Hansky, and Scott (1972) suggested that truncal vagotomy permits the release of gastrin from the antrum and other sites. They postulated that the mechanism for this release is a combination of diminution in gastric acid secretion and removal of an inhibitor to extragastric gastrin release by section of extragastric vagal fibres. The validity of this hypothesis has been examined in patients with duodenal ulcer by comparing gastrin levels following selective gastric vagotomy with those following truncal vagotomy. If the hypothesis is correct then selective gastric vagotomy by preservation of extragastric vagal fibres should permit the inhibitor to remain active and prevent the release of extragastric gastrin. Material and Methods After an overnight fast, serum gastrin was estimated in 30 patients who had undergone bilateral selective gastric vagotomy and drainage for active duodenal ulcer. The surgical procedure was as reported by Coupland and Cumberland (1971), the operation having been performed from one month to four years previously. Six females and 24 males comprised the grou