ABSTRACT
Post-prandial serum levels of gastrin, the main hormonal stimulator of acid secretion, have been shown to be significantly elevated after HSV compared with controls. The mechanism for this elevation is not known but could be secondary to an increased antral gastrin concentration (AGC). In this study AGCs were measured in endoscopic biopsies before and at intervals of 6 and 32 weeks after HSV in 12 patients with duodenal ulcer. Results were compared with 13 normal controls and 12 duodenal ulcer patients treated with cimetidine for 6 weeks. Blood was taken for fasting serum gastrin concentration at each endoscopy. In the HSV group AGC significantly increased on both postoperative occasions when compared with pre-operative values (P less than 0.01). AGC also showed a significant correlation with time after HSV (r = 0.71; P less than 0.01). Only one patient, who had a persistent duodenal ulcer, failed to show an increase in AGC. Cimetidine failed to increase AGCs in duodenal ulcer patients after 6 weeks of treatment. However, a subgroup (n = 7) of cimetidine-treated patients with low pretreatment AGCs, below 10 ng/mg, did show a significant rise at 6 weeks (P less than 0.05). Fasting serum gastrin levels did not change significantly in any of the three groups. It is concluded that HSV causes a significant increase in AGC with time.
Subject(s)
Cimetidine/therapeutic use , Duodenal Ulcer/metabolism , Gastrins/blood , Adult , Aged , Duodenal Ulcer/drug therapy , Female , Gastrins/metabolism , Humans , Male , Middle Aged , Postoperative Period , Pyloric Antrum/drug effects , Pyloric Antrum/metabolism , VagotomyABSTRACT
The Gastroenterology Unit of the Royal Newcastle Hospital treats all acute bleeders in the hospital and has followed a policy of conservative blood transfusion and early surgery directed to gastric ulcer upon rebleeding. A prospective study of 201 consecutive episodes is presented and compared with recent series treated more conventionally. Our patients were transfused less, and operated upon less often with a lower mortality rate in those with chronic peptic ulcers. The data suggest that a reversion to the less aggressive treatment policies of several decades ago, combined with early limited surgery directed to endoscopically proven gastric ulcer is worthy of trial.
