Hexamethonium and Atropine in Combination and of Vagotomy with Gastrojejunostomy on Human Gastric Secretion

The considerable difference of opinion which exists regarding the surgical treatment of duodenal ulcer suggests that the ideal operation has not yet been devised. The advantages of a lower morbidity rate with vagotomy and gastrojejunostomy compared with partial gastrectomy are offset by the higher incidence of recurrent ulceration in the former procedure (Cox and Kerr, 1957; Everson, Hutchings, Eisen, and Witanowski, 1957). It has been shown that the acid response to the augmented histamine test (Kay, 1953) is greater after vagotomy and gastrojejunostomy than after partial gastrectomy (Gillespie, Clark, Kay, and Tankel, 1960) and it seems possible that this may be responsible for the higher incidence of recurrent ulceration. However, the range of reduction in acid output which could be achieved was wide, and some patients after vagotomy with gastrojejunostomy exhibited acid reductions comparable to those achieved by partial gastrectomy. It has been shown (Kay and Smith, 1956) that hexamethonium and atropine given in combination will inhibit spontaneous acid gastric secretion and motility through their acetylcholine blocking action. In this investigation we have compared the effect of hexamethonium and atropine with vagotomy and gastrojejunostomy on spontaneous and maximal gastric acid secretion, the latter being estimated by means of the augrnented histamine test. It will be shown that significant correlations exist for maximal secretion. This raises the possibility that the effect