Antral function and recurrent ulceration

Acid secretion in relation to recurrence of duodenal ulcer after vagotomy and drainage

The acid secretory responses of patients with recurrent ulcer after vagotomy and drainage have been compared retrospectively with those of patients with a positive insulin test but no recurrent ulcer and with those of patients with a negative insulin test. Patients with recurrent ulcer were on average 10 years younger than patients with an incomplete vagotomy but no recurrence, although their preand postoperative acid secretory responses were similar.

Insulin tests were unreliable when performed less than 3 months after vagotomy. The only possible criterion by which recurrent ulceration could be predicted was a postoperative reduction in the peak acid output after pentagastrin of less than 60 per cent. Equal numbers of patients with ‘early’ and ‘late’ positive responses to insulin developed a recurrent ulcer.

Routine postoperative insulin tests may be helpful in assessing the efficiency of the vagotomist but are of limited prognostic value.

The chief value of postoperative insulin tests appears to be in the diagnostic evaluation of postvagotomy dyspepsia.