Abstract

The effect of resective and nonresective surgery on gastrin acid output and gastrin release was assessed in 63 peptic ulcer patients. Four types of operations were compared: (i) highly selective vagotomy, HSV (n=12), (ii) truncal vagotomy and pyloroplasty, VTP (n=25), (iii) partial gastric resection with gastroenterostomy of Roux-en-Y (n=11) or Billroth-II (n=3) type supplemented with truncal vagotomy, Roux(B-II)+VT, and (iv) partial gastric resection with Billroth-I gastroduodenoanastomosis (n=11) usually combined with truncal vagotomy (n=9), B-I+(VT). Although all the operations brought about a significant decrease in the basal and pentagastrin-stimulated gastric acid secretion, resective procedures proved to be significantly more effective in suppression of acid output - for the maximal acid output the differences were significant at the level: Roux(B-II)+VT vs HSV - p < 0.002, Roux(B-II)+VT vs VTP - p < 0.001, B-I+(VT) vs HSV - p < 0.01, B-I+(VT) vs VTP - p < 0.02. Vagal denervation of the stomach alone resulted in augmented serum gastrin levels, however only in the case of HSV the respective differences were statistically significant: p < 0.05 for both the fasted serum gastrin and the integrated postprandial gastrin release. The effect of a combination of partial gastric resection with truncal vagotomy on gastrinaemia was dependent on the type of the reconstructive procedure applied: a trend towards a lowering of fasted and postprandial serum gastrin levels was observed with a gastroduodenoanastomosis [B-I+(VT)] without, however, reaching the level of statistical significance, whereas a significant decrease (p < 0.001) in the meal-stimulated gastrin output was found in the gastroenterostomy [Roux(B-II)+VT] patients. The postprandial gastrin release was significantly lower in Roux(B-II)+VT patients than in those with HSV (p < 0.01) or VTP (p < 0.005). Taking into account the postoperative fasted gastrinaemia and the postprandial gastrin release, the operations compared could be ranged as follows: VTP > HSV > B-I+(VT) > Roux(B-II)+VT. The clinical relevance of the findings of the study is discussed.

Keywords: Peptic Ulcer, Gastric Acid, secretion, gastrin, surgical treatment, Vagotomy