Impaired pancreatic innervation after selective gastric vagotomy. Reduction of the pancreatic polypeptide response to food and insulin hypoglycemia.

The secretion of pancreatic polypeptide (PP) was studied in 38 duodenal ulcer patients before, 4 months after, and, in 25 patients, again 18 months after either selective gastric vagotomy or parietal cell vagotomy. Selective gastric vagotomy on average reduced the PP response to food measured 4 months after operation to 20% of the preoperative value. The prolonged PP response (30-120 min) increased to 50% from the 4th to the 18th postoperative month (p less than 0.005). Parietal cell vagotomy did not significantly change the PP response to food, although in a few patients (3/15) the response was reduced to below one third of the preoperative value. The PP response to insulin hypoglycemia was measured after operation in 16 patients; those who had a reduced PP response to food demonstrated a response to hypoglycemia which was reduced to the same extent. It is concluded that PP secretion is generally unaffected by parietal cell vagotomy but is impaired after selective gastric vagotomy and that the prolonged PP response to food is partially regenerated after vagotomy. It is suggested that selective gastric vagotomy interferes with the vagal innervation of the PP-rich head of the pancreas.

Abnormal duodenal loop demonstrated by X-ray. Correlation to symptoms of dyspepsia.

In 73 patients the occurrence of dyspeptic symptoms were correlated with the presence of a normal duodenal loop (29 patients) and an abnormal duodenal loop (44 patients). An abnormal duodenal loop was associated with a significantly higher incidence of symptoms provoked by meals, vomiting, regurgitation, heartburn, and the irritable bowel syndrome.

Abnormal duodenal loop demonstrated by X-ray. Relation to gastric emptying time.

Gastric emptying time of a solid meal was estimated on X-ray in 7 patients with a normal duodenal loop, 7 patients with a proximal duodenal anomaly, and 12 patients with a distal duodenal anomaly. A determination coefficient between gastric emptying time and duration of serum gastrin increase was calculated. The food-stimulated serum gastrin secretory pattern was studied in 9 patients with a normal duodenal loop, 6 with a proximal duodenal anomaly, and 13 with a distal duodenal anomaly. The various groups presented significantly different gastric emptying times; thus patients with normal duodenal loop had a mean gastric emptying time of 6 h, patients with proximal duodenal anomalies ahd a mean gastric emptying time of 4.5 h, and patients with distal duodenal anomalies had a mean gastric emptying time of 9 h. Gastric emptying time and duration of increased serum gastrin secretion was positively correlated (R2 = 0.89). The food-stimulated serum gastric secretory pattern was equal in patients with proximal duodenal anomalies and those with distal duodenal anomalies and furthermore, reached significantly higher serum gastrin concentrations than in patients with a normal duodenal loop.

Food-stimulated serum calcitonin concentrations in patients with ulcer negative dyspepsia, duodenal ulcer and in controls.

In 12 normals serum calcitonin (CT) concentration decreased significantly when eating wtih a return to basal value and a significant postprandial fall. No difference was observed in the food-stimulated CT secretion between duodenal ulcer patients and normals. In 25 patients with ulcer negative dyspepsia a significant increase in serum CT concentration occurred during food intake followed by a return to basal level and a secondary significant rise. The pattern in patients with ulcer negative dyspepsia differed significantly from patients with duodenal ulcer and normals.

Serum gastrin concentration before and after parietal cell vagotomy in man and dog.

Serum gastrin concentrations were measured during fasting and after feeding in duodenal ulcer patients and in dogs before and after parietal cell vagotomy (PCV). Postoperatively, fasting serum gastrin concentrations increased significantly in man and insignificantly higher in dog. After feeding, serum gastrin reached higher values postoperatively in both man and dog. The percentage rise in food-stimulated serum gastrin after PCV was higher in dog than in man.