Gastric secretory investigation of recurrent ulcer after surgery for duodenal ulcer.

The results of gastric secretory studies in 192 cases of recurrent ulcer after surgery for duodenal ulcer were analyzed and compared with the secretory data collected in a control group of 74 duodenal ulcer patients who had undergone various forms of gastric surgery, but who did not develop a recurrent ulcer (controls). The patients studied comprised 46 cases of recurrent ulcer after partial gastrectomy, 10 cases of recurrent ulcer after partial gastrectomy and bilateral truncal vagotomy, 56 cases of recurrent ulcer after truncal vagotomy and drainage, 52 cases of recurrent ulcer after highly selective vagotomy, and finally 28 cases in which the recurrent ulcer led to the diagnosis of the Zollinger-Ellison syndrome. The entire study was based upon an analysis of the basal acid output, the response to maximal stimulation by pentagastrin or by histalog and by insulin in the case of previous vagotomy, and finally on an assessment of basal serum gastrin. The analysis has suggested minimal secretory levels with discriminative values useful for the postoperative diagnosis of recurrent ulcer and for an assessment of the completeness of vagotomy (ratio PAO Insulin/PAO pentagastrin or histalog). Moreover, an analysis of various elements of the sequential basal pentagastrin-insulin test permitted us to approach the pathophysiological mechanism responsible for ulcer recurrence, and to identify suitable criteria for selection of the best treatment.

[The value of endoscopic sclerotherapy in the treatment of gastroduodenal hemorrhagic ulcers]. / Intérêt de la sclérothérapie endoscopique dans le traitement des ulcères hémorragiques gastroduodénaux.

Mortality in upper GI tract bleeding has not been affected by the introduction of diagnostic fibre optic endoscopy. Recently, however, several modes of treatment delivered through the endoscope have been shown to be effective in improving the outcome of bleeding ulcers. We have retrospectively evaluated the course of 58 patients who underwent endoscopic treatment of a bleeding ulcer. Hemostasis was initially obtained in 93% of patients. 19 (34%) had a relapse of hemorrhage and 15 of these underwent emergency operation. 5 patients (8.6%) died; one of these deaths was due to a complication of endoscopic treatment. Definitive hemostasis was obtained in 41 patients (71%). Endoscopic sclerotherapy of bleeding gastroduodenal ulcers is effective, simple, and cheap, and should be considered in all patients presenting a high risk of relapse.