Parietal cell vagotomy for duodenal and pyloric ulcers: II. Histopathology and gastric secretion

Abstract

The clinical follow-up of patients with parietal cell vagotomy for duodenal and pyloric ulcers revealed more recurrent symptoms of ulcer in patients with pyloric ulcer. In an attempt to explain this finding, the clinical results were related to the results of histopathologic examination and gastric secretion tests. The location of the microscopic antral-fundic boundary in relation to the distal limit of denervation, as an indicator of the extent of denervation at the minor curvature, was found to be the same in patients with both types of ulcer and also in patients with and without recurrent symptoms of ulcer. The grade of gastritis was also found to be the same in the mentioned categories. Patients with duodenal and pyloric ulcer did not differ in their response to insulin postoperatively according to 10 criteria for incomplete vagotomy. More positive insulin tests were found in patients with recurrent symptoms of ulcer in both the duodenal and pyloric ulcer groups. In absolute values of gastric secretion, duodenal ulcer patients were found to have significantly higher values both pre- and postoperatively than pyloric ulcer patients, but both groups had the same postoperative reduction. Significantly higher postoperative gastric secretion was found in duodenal ulcer patients with recurrent ulcer symptoms than in those without, whereas the same differences in pyloric ulcer patients were small and insignificant. The higher rate of recurrent ulcer symptoms in pyloric ulcer patients than in duodenal ulcer patients cannot be explained either by anatomically or physiologically inadequate vagotomies or by differences in grade of gastritis.