ABSTRACT
During the past two decades, major advances have been made in our understanding of basic gastric physiology. Appreciation of cellular biology has contributed to rapid progress in gastric pharmacology. Clinicians may choose from a large and rapidly growing list of antiulcer drugs. The proper choice of medical or surgical therapy depends on knowledge of the pathophysiology of peptic ulceration and of the inherent limitations of each approach. Selective drug use, tailoring of medical regimens to individual clinical situations, and the combination of medical and surgical treatments will play prominent roles in the future management of peptic ulceration.
Subject(s)
Duodenal Ulcer/surgery , Stomach Ulcer/surgery , Duodenal Obstruction/surgery , Duodenal Ulcer/epidemiology , Duodenal Ulcer/physiopathology , Gastrectomy , Humans , Parietal Cells, Gastric/innervation , Peptic Ulcer Hemorrhage/surgery , Peptic Ulcer Perforation/surgery , Pyloric Antrum/surgery , Stomach Ulcer/epidemiology , Stomach Ulcer/physiopathology , United States , Vagotomy/methodsABSTRACT
Antral gastrin-producing cell densities, as well as serum gastrin and gastric acid secretion were obtained prior to parietal cell vagotomy from 60 patients suffering from chronic duodenal ulcer disease. Acid secretion was also measured postoperatively. The patients were followed for five years. The ulcer recurrence rate was 20%. No differences were found in the G-cell densities, fasting serum-gastrin or gastric acid secretion preoperatively between the two groups: recurrence and non-recurrence. The acid secretion was higher postoperatively in patients with recurrent ulcer as compared to those without recurrence of the ulcer, suggesting that incomplete vagotomy is a reasonable explanation of the recurrence, even though post-operative G-cell abnormality cannot definitely be ruled out.
