Maximal Acid Response to Histamine in Duodenal Ulcer Patients Subjected to Resection of the Antrum and Duodenal Bulb Followed by Vagotomy

Summary The maximal acid response of the stomach to histamine was determined in 13 duodenal ulcer patients before and after resection of the antrum and duodenal bulb, then again following vagotomy. Antrectomy was done with the guidance of visualization at operation of the antrumcorpus border. For vagotomy, 1 week after the gastric surgery, a special procedure was used which did not necessitate a second laparotomy. The maximal acid response to histamine showed a mean reduction of 51% after resection of the antrum and duodenal bulb. This depressed postresection response was in turn reduced by 67% following vagotomy. In a group of 8 patients with the same disease, pyloroplasty and subsequent vagotomy resulted in a significantly smaller reduction of the maximal response. The results confirm that resection of the antrum and duodenal bulb significantly reduces the maximal acid response to histamine in man and show that subsequent vagotomy causes a further significant suppression of this response, indicating that in man the parietal cell response to maximal histamine stimulation is facilitated both by basal release of gastrin and by direct vagal activation of the parietal cells via a basal flow of vagal impulses.