Graded vagotomy and gastric secretion

In 3 dogs with gastric fistulae, partial denervation of the acid secreting area of the stomach halved the insulin-stimulated acid secretion. Completion of a “highly selective” (proximal gastric) vagotomy resulted in a further fall of the peak acid output after insulin to 4% of control values, and there was no further change when selective and truncal vagotomy were performed. The pentagastrin dose-response curve was shifted to the right after partial denervation and remained so shifted after subsequent operations. At low doses there was a considerable decrease in acid output, and the maximal acid output was unchanged but achieved only with a higher dose of pentagastrin. These results suggest that the gastric secretory response after vagotomy is not an all-or-none phenomenon and that the fall in peak acid output after insulin is related to the extent of the acid-secreting mucosa denervated. Tailored vagotomy operations might lower the acid secretion sufficiently to heal an ulcer without interfering with other aspects of gastrointestinal function.