Gastric Mucosal Structure and Function after Vagotomy.

Vagotomy, combined with a drainage procedure, has become increasingly popular in the surgical treatment of chronic duodenal ulcer. After operation the nervous phase of gastric secretion is abolished and the maximum secretory response to histamine, varying in degree from 70% (Falconer, 1959) to 80 %, (Gillespie, Clark, Kay, and Tankel, 1960) is reduced. The role of the vagus nerves in gastric secretion is known to be a complex one, and the mechanism responsible for the marked reduction in gastric secretory capacity following vagotomy has been the subject of much recent investigation. It is known that the responsiveness of the parietal cells to secretory stimuli depends upon intact vagal innervation, and there is evidence (Payne and Kay, 1962) that withdrawal of the permissive role of the vagus following section of the vagus nerve is an important factor in reducing acid secretory capacity. It is also possible that the continued and prolonged suppression of acid secretion following section of the vagal pathways could result from parietal cell hypoplasia and atrophy, perhaps as a manifestation of withdrawal of 'trophic' influence. No other factors which might contribute to the observed reduction in gastric acid output have been clearly identified. The associated drainage operation plays no part in producing the fall in acid secretion, since neither gastroenterostomy alone (Tankel, Gillespie, Clark, Kay, and McArthur, 1960) nor pyloroplasty alone (Gelb, Baronofsky, and Janowitz, 1961) significantly alter the maximal acid response. Thomson and Vane (1953) have shown that the secretory response to histamine can be correlated with gastric mucosal blood flow, but evidence is lacking that vagal section maintains impairment of mucosal vascular supply. Most investigations on vagotomized patients in the past have dealt with changes in gastric secretion. In the present study the gastric mucosa has been examined in a group of subjects at intervals of up to 10 years following vagotomy, and with a few exceptions the morphological appearances have been correlated with gastric secretory capacity as determined by a modified insulin test meal procedure.