Propanthelene as an agent for medical vagotomy.

The aim of any operation for chronic duodenal ulcer is to reduce the amount of acid produced by the stomach, sufficiently to allow the ulcer to heal. Complete division of the vagi usually satisfies this criterion, but in some the reduction obtained, as measured by the augmented histamine test (Kay, 1953), may only be small (Sircus and Small, 1964). The patients in whom an adequate reduction is not obtained by vagotomy may be those who will develop further ulceration. It would obviously be an advantage if such individuals could be detected before operation. An attempt to do this was made by Gillespie and Kay (1961) using hexamethonium and atropine as medical vagotomy agents. Fairly good correlation was reported between the mean reductions of the pre-operative augmented histamine response by medical and surgical vagotomy. However, on an individual basis there was not always sufficient agreement between the two values to use the reduction achieved by medical vagotomy as a direct prediction of that achieved by surgical vagotomy. Furthermore, experience with these two agents has revealed a relatively high incidence of unpleasant side-effects, e.g., postural hypotension, blurring of vision, and delayed bladder emptying. In this study propanthelene bromide (Probanthine) was used as a medical vagotomy agent, and the results suggest that it may possess several advantages over hexamethonium and atropine.