Anastomotic Ulcer: Significance of the Augmented Histamine Test

Abstract

Summary Twenty-two patients with proven postgastrectomy anastomotic ulcer were compared with an equal number without ulcer after gastrectomy. Basal and histamine stimulated maximal acid outputs were measured using intragastric phenolsulfonphthalein infusion as an index of recovery of secretion. Both mean basal and mean maximal acid outputs after histamine were significantly increased in patients with anastomotic ulcer after partial gastrectomy. Maximal histamine acid output of more than 15 mEq/hour strongly supports the diagnosis of anastomotic ulcer. No anastomotic ulcer subject had histamine fast achlorhydria, and the presence of achlorhydria (pH 7.6) under basal circumstances virtually excluded this diagnosis. High basal rates greater than 60% of maximal rates of secretion after histamine were found in only 1 of 3 postgastrectomy patients known to have the ZollingerEllison syndrome. Two patients with retained antral in exclusion demonstrated basal rates greater than 60% of maximal histamine response and thus simulated the pattern of the Zollinger-Ellison syndrome. With the methods used, suction recovery of secretion in gastrectomized patients was adequate. Poor recovery of secretions as determined by the use of a phenolsulfonphthalein marker did not account for the absence of gastric hypersecretion in many of the ulcer group, nor could this be explained by differences in the site of the ulcer with respect to the site of the anastomosis, by delays in peak response to histamine, or by the use of an antihistaminic agent.