The Early and Delayed Phases of Gastric Acid Secretion in Response to Insulin Hypoglycemia

Abstract

In a previous communication 1 we reported that duodenal ulcer patients were invariably characterized by sustained gastric acid secretion over a period of 4 hour or longer following insulin stimulation. This response involves an immediate phase (vagal phase) and a delayed phase (pituitary-adrenal phase). In non-ulcer subjects we found two types of responses: one, the sustained response similar to that of duodenal uleer patients, and the other an unsustained response which involved mainly the vagal phase. In this study, we were interested in determining the types of gastrie acid seeretory responses which would follow insulin stimulation in duodenal ulcer patients who had undergone vagotomy with pyloroplasty. The evaluation of methods was similar to that of part I of this artiele. Two sets of data are represented. A set of complete data is represented in terms of an analysis of the pH eurve. Where the exading aspiration teehnique was used, a seeond set of data is represented in terms of milliequivalents of hydrochlorie aeid secretion. As in part I the secretory response is divided into 2 hr. phases, eonsisting of basal seeretion, early phase seeretion and delayed phase secretion. It should be stated that had we not had a large group of patients with vagotomy and pyloroplasty, this study would have been impossible. In our experience, patients having gastroenterostomy or gastrie reseetion give unreliable studies with respect to volumes and pH of gastric secretion, due to the admixture of duodenal and jejunal contents with the gastric aspirates.