Sverre Emås

Comparison of Gastric Secretion in Conscious Dogs and Cats

Summary Gastric secretion from the vagally innervated stomach in response to histamine and gastrin extract was compared in conscious dogs and cats with gastric fistulae. In both dogs and cats, the maximal rate of acid secretion was the same in response to histamine as it was in response to gastrin extract. The same dose of histamine or gastrin extract per kilogram of body weight was required to produce maximal acid response in the two species. Twice the maximal dose of histamine or of gastrin extract produced a submaximal response in the dogs but a maximal response in the cats. Pepsin output was highest to the lowest dose of histamine in both species; with increasing doses, the responses successively declined to basal level. In both dogs and cats, the pepsin output increased with increasing doses of gastrin; with supramaximal doses, the pepsin output decreased in the dogs but remained maximal in the cats. Relative to acid secretion, the cats secreted more pepsin than did the dogs.

Antral and Duodenal Gastrin Activity in Non-Ulcer and Ulcer Patients

The secretory activity of gastrin extracts from the antral and duodenal mucosa of patients operated on for duodenal or gastric ulcer, and from non-ulcer patients, was determined on conscious cats. The antral gastrin activity in the duodenal ulcer and non-ulcer patients did not differ but was twice as high as in the gastric ulcer patients. The duodenal gastrin-like activity in the duodenal ulcer and the non-ulcer patients did not differ and was about one-third of the antral activity; in the gastric ulcer patients the activity was too low to be estimated. It is concluded that the antral and duodenal gastrin activity is normal in duodenal ulcer patients and below normal in gastric ulcer patients.

Antral Gastrin Activity in Duodenal and Gastric Ulcers

Summary Gastrin has been extracted from the antral mucosa of patients operated upon; 10 for duodenal ulcer, 11 for gastric ulcer, 2 for pyloric ulcer, and 1 for gastric carcinoma. The secretory activity of the gastrin preparations has been determined on unanesthetized gastric fistula cats. A satisfactory reproducibility of the extraction procedure and of the assay technique has been demonstrated. Gastrin activity per gram of antral mucosa amounted in the duodenal ulcer patients to more than 3 times the antral gastrin activity of the gastric ulcer patients, and the difference was highly significant. In the 2 patients with pyloric ulcer, antral gastrin activity corresponded to the average antral activity of the duodenal ulcer patients, and in the 1 patient with gastric carcinoma activity was less than the average antral activity of the gastric ulcer patients. The antral gastrin activity of 4 nonulcer human autopsy specimens varied greatly and gave no reliable information concerning the gastrin activity in antra from normal stomachs. The role of antral gastrin in ulcer genesis cannot be elucidated until the antral gastrin activity of normal stomachs has been established. The difference in gastrin activity between antra from duodenal and gastric ulcer patients suggests different genesis for these ulcers.

Production of Duodenal Ulcers in cats by Infusion of Porcine Gastrin

Summary Porcine gastrin extract, pure porcine gastrin II, or saline was given by continuous intravenous injection to conscious, intact cats. The doses of gastrin selected were based on studies in other conscious cats with gastric fistulas. Two cats that received porcine gastrin extract for 12 hr in a dose that produced near maximal acid and pepsin secretion in cats with gastric fistulas had a normal appearance of the gastric and duodenal mucosa. In 7 of 8 cats that got the same dose of gastrin extract for 24 hr, erosions or ulcers occurred in the proximal duodenum, with gross bleeding in 4. Both of 2 cats that got the same dose of gastrin extract for 96 hr had duodenal ulcers, one with perforation, the other with obvious hemorrhage. One-fourth of the above dose of gastrin extract infused for 24 hr in 4 cats produced duodenal ulcers and erosions in all, but these were less severe than those produced by the larger dose. In all of 4 cats, porcine gastrin II infused for 24 hr in a dose that produced near maximal acid secretion in gastric fistula cats (2 μg per kg body wt per hr) produced severe duodenal ulcers with hemorrhage. A few of the cats with duodenal lesions had small erosions or ulcerations of the pyloric gland area or the oxyntic gland area of the stomach. In cats that received saline intravenously for 12, 24, or 96 hr the gastric and duodenal mucosa had a normal appearance.

Twelve-year follow-up of a prospective, randomized trial of selective vagotomy with pyloroplasty and selective proximal vagotomy with and without pyloroplasty for the treatment of duodenal, pyloric, and prepyloric ulcers

Between 1973 and 1981, 161 patients with prepyloric, pyloric, or duodenal ulcers were randomly allocated to selective vagotomy with pyloroplasty, selective proximal vagotomy with pyloroplasty, or selective proximal vagotomy alone. No significant differences in clinical results were found 3 years after surgery by Emås and Fernström (Am J Surg 1985; 149: 236-42). There was one postoperative death, and one patient lost to follow-up. Of 159 patients, 52 underwent selective vagotomy with pyloroplasty, 55 selective proximal vagotomy with pyloroplasty, and 52 selective proximal vagotomy alone. Fifteen patients did not undergo endoscopy, but they had no epigastric complaints. From 1 to 16 years after surgery, recurrent ulcer was detected in 13%, 18%, and 23%, respectively, after selective vagotomy with pyloroplasty, selective proximal vagotomy with pyloroplasty, or selective proximal vagotomy without pyloroplasty. Twenty-eight percent of the patients with recurrent ulcer had no symptoms and received no treatment. Sixteen patients died within 8 years after surgery of causes unrelated to the ulcer disease. At their final examination, 14 of the 16 patients had Visick I or II (modified Visick scale) results, and the disease that caused their deaths obscured evaluation in 2 patients. The remaining 143 patients were followed up for 8 to 16 years (average: 12 years). Epigastric pain with or without ulcer was recorded more often (significant) after selective proximal vagotomy alone (40%) than after selective vagotomy with pyloroplasty (17%) or selective proximal vagotomy with pyloroplasty (14%). Bowel habits were unchanged in 96% of patients who underwent selective vagotomy with pyloroplasty or selective proximal vagotomy with pyloroplasty and 100% of patients who had selective proximal vagotomy alone. Mild dumping tended to be more common after vagotomy with pyloroplasty but was a minor nuisance in only a few patients. Very good or good results (Visick I or II) were recorded in 75% of the patients after selective vagotomy with pyloroplasty or selective proximal vagotomy with pyloroplasty or selective proximal vagotomy with pyloroplasty and in 54% after selective proximal vagotomy alone (significant difference). Seventeen patients underwent reoperation with antrectomy and gastrojejunostomy Roux-en-Y (13 patients) or gastroduodenostomy (4 patients) with no mortality. The results of the reoperations were graded as Visick I or II results in all but one patient. The final grading, including the reoperations, were Visick I or II in 85% of patients after selective vagotomy with pyloroplasty and selective proximal vagotomy with pyloroplasty and in 55% after selective proximal vagotomy alone (significant difference).(ABSTRACT TRUNCATED AT 400 WORDS)

Acid responses to histamine, pentagastrin and human gastrin I in conscious cats with gastric fistulas and Heidenhain pouches.

In conscious cats provided with both a gastric fistula of the vagally innervated stomach (GF) and a vagally denervated fundic pouch (HP), the acid output in response to graded doses of histamine dihydrochloride, pentagastrin or synthetic human gastrin I was simultaneously recorded from the GF and HP. The maximal responses (MR) to the three stimulants were equal in both the GF and the HP. The dose required to produce half the MR was significantly higher in the HP than in the GF for pentagastrin and gastrin, but it did not differ for histamine. It is concluded that at submaximal doses, the relative potency of pentagastrin and gastrin in stimulating acid secretion is higher in the presence than in the absence of tonic vagal impulses to the oxyntic glands; for histamine, the potency is equal.

Six-year results of a prospective, randomized trial of selective proximal vagotomy with and without pyloroplasty in the treatment of duodenal, pyloric, and prepyloric ulcers.

In a consecutive series of patients with uncomplicated prepyloric, pyloric, or duodenal ulcer, 39 patients were randomly allocated to selective proximal vagotomy with pyloroplasty, and 40 patients to selective proximal vagotomy alone with no operative mortality. Before surgery, all patients had undergone H2-receptor antagonist treatment. No patient was lost for follow-up. At an average follow-up of 6 years, recurrent ulcer was recorded in 15% and 20%, respectively, after selective proximal vagotomy with and without pyloroplasty. Three of 14 recurrent ulcers were asymptomatic. Epigastric pain with or without ulcer was significantly less common after selective proximal vagotomy with (13%) than without pyloroplasty (40%). Mild diarrhea or mild dumping was recorded in a few patients. The overall results were very good or good (Visick I or II) in 77% and 55% (significant difference) after vagotomy with and without pyloroplasty, respectively, and in 82% and 58%, if asymptomatic ulcers were graded as Visick I or II results. Of the 27 patients with Visick 111 or IV results, three patients needed no treatment (asymptomatic ulcers), and 10 patients had no symptoms during medical treatment. Two patients with vagotomy and pyloroplasty and nine with vagotomy alone were reoperated. There were no deaths, and the results were graded as Visick I or II in 10 patients and as Visick III in one patient. The authors conclude that selective proximal vagotomy with pyloroplasty is superior to vagotomy alone for the treatment of prepyloric-pyloric and duodenal ulcer. Recurrent ulcer after vagotomy has a benign course and responds well to ranitidine treatment.

Postprandial Acid Secretion and Serum Gastrin Response before and after Exclusion of the Proximal Small Intestine in Cats

The Heidenhain pouch acid output to graded does of pentagastrin and the maximal Heidenhain pouch acid and serum gastrin responses to feeding were determined in conscious cats before and after exclusion of the proximal small intestine. Exclusion did not change the secretory capacity and sensitivity of the oxyntic glands to pentagastrin. The acid and gastrin (components III and IV) responses to feeding were also unaltered. Duodenal gastrin is therefore of no significance for the postprandial acid response. Nevertheless, the duodenum is implicated in the postprandial acid secretion, since food in the duodenum release a factor that augments the maximal acid response to exogenous gastrin. The unchanged postprandial acid response after exclusion implies that this factor is not localized exclusively in the proximal small intestine.

Effect of Duodenal Acidification or Exogenous Secretin on Gastric Acid Secretion Stimulated by Histamine, Pentagastrin or Human Gastrin I in Conscious Cats

In conscious cats with gastric fistulas (GF) and Heidenhain pouches (HP), closing the GF, or closing the GF and infusing 1.8 mEq/hour of hydrochloric acid through the GF did not alter histamine or pentagastrin stimulated acid secretion from the HP. In conscious GF cats a rapid i.v. injection of 5 or 20 U/kg of secretin did not alter histamine stimulated acid secretion but reduced pentagastrin and gastrin stimulated secretion by 30–40%. The results suggest that physiological amounts of acid entering the duodenum do not inhibit pentagastrin stimulated acid secretion from the HP in cats in contrast to in dogs

Heidenhain Pouch Response to Antral Stimulation before and after Antral Denervation in Dogs

Summary In dogs with Heidenhain pouches and vagally innervated antral pouches, denervation of the antral pouch produced the following effects on secretion of acid from the Heidenhain pouches: (a) the responses to submaximal doses of exogenous gastrin extract and to histamine were not significantly changed, (b) the response to 2-deoxy-D-glucose, which presumably acts by vagal release of gastrin, was greatly decreased, and (c) the response to bathing the mucosa of the antral pouch with solutions of acetylcholine or glycine was greatly decreased. The results suggest that tonic vagal impulses facilitate the local release of gastrin by acetylcholine and glycine.