Effect of endogenous pancreatic glucagon on gastric acid secretion in patients with duodenal ulcer before and after parietal cell vagotomy.

F B Loud,P Kirkegaard,J Chirstiansen,J J Holst,B Petersen

doi:10.1136/gut.22.5.359

Abstract

The effect of endogenous pancreatic glucagon on submaximal pentagastrin stimulated gastric acid secretion was studied by infusion of 1-arginine in patients with duodenal ulcer before and after parietal cell vagotomy without drainage (PCV). Preoperatively infusion of 1-arginine resulted in a marked inhibition of acid secretion, whereas no effect was found postoperatively. Plasma glucagon concentrations were identical pre- and postoperatively, fasting as well as during arginine infusion. Serum gastrin concentration rose after PCV but not unaffected by arginine infusion both pre- and postoperatively. The study demonstrates that intact vagal innervation of the fundic glands is a condition of inhibition of pentagastrin induced acid secretion by pancreatic glucagon released by infusion of 1-arginine.

Highlights

MethodsTwelve patients with duodenal ulcer, nine men and three women, median age 40 years (range 22-58 years) were studied
Previous studies have suggested that pancreatic glucagon plays a part in the physiological inhibition of gastric acid secretion.' Glucagon inhibition of gastrin stimulated acid secretion follows non-competitive kinetics,' but the nature of the inhibitory action is otherwise unknown
The patients had a parietal cell vagotomy without drainage (PCV) performed according to a standard technique described elswhere

Summary

Methods

Twelve patients with duodenal ulcer, nine men and three women, median age 40 years (range 22-58 years) were studied. The patients had well-documented chronic duodenal ulcer disease and a radiologically and endoscopically verified duodenal ulcer. None had any evidence of gastric outlet obstruction or had had any recent complications, such as bleeding or perforation. The patients had a PCV performed according to a standard technique described elswhere.. It should be emphasised that the main trunks of the vagus nerve were isolated to avoid any injury to these nerves. The patients were studied before and two to three months after the operation as described below

Results

Discussion

Conclusion