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British Medical Journal (Clinical... Apr 1985A simple model of a Markov chain was used to study the long term outcome of different strategies for the treatment of duodenal ulcer. Maintenance treatment with H2... (Comparative Study)
Comparative Study
A simple model of a Markov chain was used to study the long term outcome of different strategies for the treatment of duodenal ulcer. Maintenance treatment with H2 receptor antagonists surpassed intermittent drug treatment and proximal gastric vagotomy with respect to the relapse free interval and severe postoperative morbidity. With maintenance treatment the rate of complications and the number of deaths related to ulcer were slightly higher than after proximal gastric vagotomy. Nevertheless, because the few deaths from proximal gastric vagotomy occur at the initiation of treatment the loss of life years during maintenance treatment exceeded that of proximal gastric vagotomy only after 20 years. Despite its rarity, severe postoperative morbidity after proximal gastric vagotomy far exceeded that after the few emergency operations which would become necessary in the course of maintenance treatment. The superiority of maintenance treatment over proximal gastric vagotomy remained insensitive to changes in the assumptions underlying the recurrence rate with both treatments and the postoperative morbidity of proximal gastric vagotomy.
Topics: Duodenal Ulcer; Histamine H2 Antagonists; Humans; Recurrence; Time Factors; Vagotomy; Vagotomy, Proximal Gastric
PubMed: 2859078
DOI: 10.1136/bmj.290.6476.1185 -
Annals of Surgery Oct 1983Recent reviews have documented significant delayed gastric emptying following Roux-Y biliary diversion for alkaline gastritis. This study establishes the use of... (Comparative Study)
Comparative Study
Recent reviews have documented significant delayed gastric emptying following Roux-Y biliary diversion for alkaline gastritis. This study establishes the use of radionuclide imaging in the experimental model and evaluates the following: (1) gastric emptying following antrectomy with and without vagal denervation; (2) the effect of Roux-Y diversion on gastric and upper gastrointestinal emptying using animals as their own controls; and (3) the role of truncal vagotomy in the "Roux-Y delayed emptying syndrome." Upper gastrointestinal emptying was evaluated in 8 dogs using the radionuclide technetium 99 labeled egg white method with continuous visualization by gamma camera. Eight dogs underwent B-II antrectomy without vagotomy and were divided into two groups. Four underwent vagotomy, re-evaluation, and Roux-Y diversion. Four underwent Roux-Y diversion first, re-evaluation, then truncal vagotomy. Control dogs retained 65% +/- 4% (SEM) and 45% +/- 6% of ingested food at 2 and 4 hours, respectively. Following antrectomy only, rapid gastric emptying of radionuclide solid is observed with 35% +/- 7%, 16% +/- 4% and 7% +/- 4% retention and 2, 3, and 4 hours, respectively. Roux-Y antrectomy without vagotomy results in similar rapid gastric emptying. Truncal vagotomy following B-II antrectomy delays gastric emptying compared to antrectomy only. Truncal vagotomy and Roux diversion results in varied patterns of gastrointestinal emptying. Significant gastric retention and gastric and Roux limb retention are observed in 25% of trials. Significant Roux limb retention is observed in 45% of the group. Prior to vagotomy there is no retention or altered transit in the Roux limb. In general, no delay in gastrointestinal emptying is observed in the absence of vagal denervation. These data corroborate our clinical experience in observing both Roux and gastric retention following radionuclide evaluation in Roux-Y patients.
Topics: Animals; Dogs; Gastric Emptying; Gastroenterostomy; Postgastrectomy Syndromes; Pyloric Antrum; Radionuclide Imaging; Stomach; Vagotomy
PubMed: 6625721
DOI: 10.1097/00000658-198310000-00010 -
Annals of Surgery Jan 1983Experience with proximal gastric vagotomy at the Mayo Clinic from 1973 to Mayo 1980 is reported. Among 298 patients who had proximal gastric vagotomy for chronic...
Experience with proximal gastric vagotomy at the Mayo Clinic from 1973 to Mayo 1980 is reported. Among 298 patients who had proximal gastric vagotomy for chronic duodenal, pyloric channel, or prepyloric ulcers, a recurrent ulcer rate of 7% was present, with a mean follow-up of 49 months. Three recurrences developed in six patients who had proximal gastric vagotomy for gastric ulceration. In 40 patients, proximal gastric vagotomy was combined with gastrojejunostomy, pyloroplasty, or pyloric dilatation for obstructing ulcers. There was a 15% incidence of reoperation in the gastrojejunostomy group. All nine patients who had proximal gastric vagotomy for active or recent bleeding ulcers were dismissed from the hospital without further hemorrhage, and only one developed a recurrent ulcer. It is concluded that proximal gastric vagotomy remains an acceptable operation for chronic duodenal and pyloric ulcers, but its efficacy in gastric ulcers is unproved.
Topics: Female; Follow-Up Studies; Gastroenterostomy; Humans; Jejunum; Male; Middle Aged; Peptic Ulcer; Peptic Ulcer Hemorrhage; Pyloric Antrum; Recurrence; Vagotomy; Vagotomy, Proximal Gastric
PubMed: 6848052
DOI: No ID Found -
Annals of Surgery Jun 1985In the past 10 years, 163 patients with documented gastric ulcers were treated at Vanderbilt University and Metropolitan Nashville General Hospitals. One hundred...
In the past 10 years, 163 patients with documented gastric ulcers were treated at Vanderbilt University and Metropolitan Nashville General Hospitals. One hundred thirty-five were initially managed medically. Medical therapy was successful in 58 patients (43%) in this group. Twenty-eight (17%) patients required surgical treatment initially. An additional 77 patients (57%) became candidates for surgical management when their medical management failed. Of this group, 40 now have been surgically treated and 37 still have symptoms while on medical treatment. Three patients being treated for benign ulcers, two for as long as six years each, were found to have carcinoma of the stomach diagnosed by subsequent endoscopy and biopsy in one and by laparotomy with gastrectomy to include the ulcer in two. We consider subtotal gastrectomy or surgical resection of the antrum, including the ulcer site, to be the preferred surgical treatment for gastric ulcers, and this was done in 50 cases. Vagotomy was done in addition to the antrectomy in 31 of these, and in addition to the subtotal resection in 11. Two patients who had vagotomy and resection subsequently developed a marginal ulcer. One of these who had a subtotal resection and vagotomy healed with medical treatment. The one who had a vagotomy and antrectomy required a second vagotomy for a missed vagus nerve. Gastrointestinal endoscopy in the past 10 years has improved to the point that very few malignant ulcers are missed by endoscopic biopsy. Large ulcers, those that perforate or continue to bleed, and those that fail to heal on medical treatment for a maximum of 2 to 3 months should be submitted to an antrectomy that includes the ulcer. Vagotomy should be added in selected cases.
Topics: Adolescent; Adult; Aged; Child; Child, Preschool; Combined Modality Therapy; Duodenal Ulcer; Female; Gastrectomy; Humans; Male; Middle Aged; Postoperative Complications; Reoperation; Stomach Ulcer; Vagotomy
PubMed: 4004386
DOI: 10.1097/00000658-198506000-00011 -
Annals of Surgery May 1987This is a progress report of a prospective, randomized study involving 200 consecutive patients treated electively with either parietal cell vagotomy (PCV) or selective... (Clinical Trial)
Clinical Trial Comparative Study Randomized Controlled Trial
This is a progress report of a prospective, randomized study involving 200 consecutive patients treated electively with either parietal cell vagotomy (PCV) or selective vagotomy and antrectomy (SV-A). Both groups comprised patients with pyloric, prepyloric, or duodenal ulcers. There was no operative mortality in either group. Patients were examined at 2, 6, 12 months, and every 12 months thereafter for 8-10 years. The two operations produced no statistical difference in the frequency of diarrhea. Dumping (p less than 0.0005) and weight loss (p less than 0.0005-p less than 0.05) were statistically less after PCV than after SV-A. There were two recurrent ulcers (2.2%) after SV-A. One was treated successfully by medical therapy and one patient suspected of having gastrinoma had total vagotomy. Nine patients had recurrent ulcers in the PCV group for an accumulated recurrence rate of 10.1% at 10 years by life-table analysis. There was a significant difference (p less than 0.033) between the curves for recurrent ulcers in the two groups of patients. The recurrent ulcer rate after PCV was 21% for patients with pyloric and prepyloric ulcers and 6% for patients with duodenal ulcer. There was no significant difference between the recurrent ulcer rate for PCV and SV-A if the patients with pyloric and prepyloric ulcers were withdrawn from the study. Of the nine patients with recurrent ulcers in the PCV group, three had an inadequate vagotomy and four had a pyloric or prepyloric ulcer before operation. Three patients were successfully treated with antrectomy. Five patients were treated successfully by medical therapy and remained healed for long periods without recurrence. One patient had five recurrences. He declined operation and remained free of symptoms for 3 years after his last recurrence. Poor gastric emptying necessitated gastroenterostomy in five patients in the SV-A group and in one patient in the PCV group. Patients' clinical results were evaluated according to a simple Visick grading scale. A significantly (p less than 0.0005) greater number of patients were in Visick I category after PCV than after SV-A. The clinical results obtained with PCV make this the operation of choice for the elective surgical treatment of duodenal ulcers even though the results obtained with SV-A were good.
Topics: Adult; Body Weight; Clinical Trials as Topic; Diarrhea; Dumping Syndrome; Duodenal Ulcer; Gastrectomy; Gastric Acid; Gastrointestinal Diseases; Humans; Middle Aged; Postoperative Complications; Prospective Studies; Pyloric Antrum; Random Allocation; Recurrence; Vagotomy; Vagotomy, Proximal Gastric
PubMed: 3555364
DOI: 10.1097/00000658-198705000-00017 -
Annals of Surgery May 1978This study provides a retrospective comparative analysis of results in 90 women patients who underwent three different elective operations for intractable duodenal ulcer... (Clinical Trial)
Clinical Trial Randomized Controlled Trial
Results of elective duodenal ulcer surgery in women: comparison of truncal vagotomy and antrectomy, gastric selective vagotomy and pyloroplasty, proximal gastric vagotomy.
This study provides a retrospective comparative analysis of results in 90 women patients who underwent three different elective operations for intractable duodenal ulcer disease. Group I (30 patients) underwent truncal vagotomy/antrectomy (TV + A); group II (30 patients) gastric selective vagotomy/pyloroplasty (GSV + P); and Group III proximal gastric vagotomy (PGV). There were no operative deaths among the 90 patients. No patient after TV + A has developed a recurrent ulcer. Two recurrent ulcers developed after GSV + P, and one gastric ulcer occurred after PGV. Dumping, diarrhea, and reflux gastritis were lower after PGV than with TV + A and GSV + P. Follow-up studies have been from six months to ten years. The clinical results among the three groups of women patients compare favorably with results obtained in a recent prospective randomized study using the identical operative procedures in three groups of men patients operated upon for intractability. There was no statistically significant difference between women and men after similar operative procedures, but the postgastrectomy sequelae were less after PGV in both women and men patients.
Topics: Adult; Duodenal Ulcer; Duodenum; Evaluation Studies as Topic; Female; Follow-Up Studies; Gastrectomy; Gastric Juice; Humans; Middle Aged; Postoperative Complications; Pyloric Antrum; Recurrence; Secretory Rate; Sex Factors; Stomach Ulcer; Vagotomy
PubMed: 646496
DOI: 10.1097/00000658-197805000-00017 -
Annals of Surgery Mar 1985The incidence and prevalence of gallstones has been documented in 289 consecutive patients with peptic ulcer disease, at the time of antrectomy and gastroduodenostomy...
The incidence and prevalence of gallstones has been documented in 289 consecutive patients with peptic ulcer disease, at the time of antrectomy and gastroduodenostomy (with or without truncal or selective vagotomy) and again during a 5-year follow-up period. By comparing the preoperative prevalence of gallstone disease in one age group with the prevalence 5 years after the gastric operation in another group of patients who were 5 years younger at the operation, the incidence of gallstone production due to the gastric operation could be calculated independent of the age factor. Within 5 years of the gastric operation, 18% of the patients who were normal at the time of operation produced gallstones. The incidence of new gallstones during the 5-year postgastrectomy follow-up was the same in men and women, and was increased by 7 to 15% in each age group of men. The incidence of new gallstones was 30% after truncal and 12% after selective vagotomy (p less than 0.05). Gallstone formation seems to be a sequel of Billroth I gastric resection. Truncal vagotomy in addition to the gastrectomy increases the risk of gallstone disease; patients with selective vagotomy and antrectomy had an incidence of postoperative gallstones which was the same as patients with antrectomy alone.
Topics: Adult; Aged; Body Weight; Cholelithiasis; Duodenal Ulcer; Duodenum; Female; Follow-Up Studies; Humans; Male; Middle Aged; Postoperative Complications; Pyloric Antrum; Sex Factors; Stomach; Stomach Ulcer; Vagotomy
PubMed: 3977432
DOI: 10.1097/00000658-198503000-00010 -
Digestive Diseases and Sciences May 2012
Topics: Afferent Pathways; Animals; Capsaicin; Glucose; Male; Obesity; Sensory Receptor Cells; Vagotomy
PubMed: 22438205
DOI: 10.1007/s10620-012-2122-7 -
Annals of Surgery Jul 1982In a prospective five-year follow-up study of 289 consecutive patients subjected to antrectomy and gastroduodenostomy with or without vagotomy, 130 patients underwent...
In a prospective five-year follow-up study of 289 consecutive patients subjected to antrectomy and gastroduodenostomy with or without vagotomy, 130 patients underwent gastroscopy. Gastric mycosis was present almost exclusively in patients subjected to combined antrectomy and vagotomy (36%). Gastric acidity seemed to be of only minor or no importance in the development of the mycosis. The residual volume in the gastric remnant was significantly higher in patients with gastric mycosis. The impaired emptying of the gastric remnant is most likely a vagotomy effect and may be the main reason for the development of gastric mycosis. A simple but effective method was developed to evacuate gastric yeast cell aggregates. Gastric mycosis seems to give rise to only slight symptoms, mainly nausea and foul-smelling belching, whereas the reflux of duodenal contents that often occurred in combination with gastric mycosis was more likely to cause gastritis and substantial discomfort.
Topics: Bile Reflux; Duodenum; Gastric Acid; Gastric Emptying; Gastroenterostomy; Gastroscopy; Humans; Mycoses; Postoperative Period; Prospective Studies; Pyloric Antrum; Stomach Diseases; Vagotomy
PubMed: 7092348
DOI: 10.1097/00000658-198207000-00005 -
The Journal of Clinical Investigation May 1983To determine whether intravenous infusion of individual amino acids stimulated gastric acid secretion in man, graded doses of phenylalanine, tryptophan, glycine,...
Intravenous infusion of L-isomers of phenylalanine and tryptophan stimulate gastric acid secretion at physiologic plasma concentrations in normal subjects and after parietal cell vagotomy.
To determine whether intravenous infusion of individual amino acids stimulated gastric acid secretion in man, graded doses of phenylalanine, tryptophan, glycine, alanine, histidine, and NaCl control were infused on separate days in nine healthy subjects. Intravenous infusion of phenylalanine and tryptophan significantly stimulated gastric acid secretion to 50 and 52%, respectively, of the acid secretory response to intragastric peptone. Intravenous alanine and histidine were without effect, whereas glycine produced a slight response. Serum gastrin concentrations did not significantly change during intravenous amino acid infusion, except in response to 0.1 M phenylalanine. However, the increase in serum gastrin occurred 2 h after acid secretion had significantly increased in response to the 0.025 M phenylalanine infusion. Plasma amino acid concentrations were measured during intravenous amino acid infusion and in response to a steak meal in five of the subjects. At a time when acid secretion was significantly increased during intravenous infusion of phenylalanine and tryptophan, plasma amino acids were similar to, or less than, that observed after the steak meal, suggesting that circulating levels of these three amino acids have a physiologic effect on gastric secretion in man. Intravenous infusion of a combination of graded doses of phenylalanine plus a continuous infusion of 0.01 M tryptophan shifted the dose-response curve to the left and resulted in a significantly greater response than to either amino acid alone. In five subjects with parietal cell vagotomy, intravenous phenylalanine and tryptophan stimulated acid secretion, whereas histidine was without effect, similar to normal subjects. These studies indicate that intravenous infusion of small amounts of phenylalanine (0.025 M, 3.1 mmol/h) and tryptophan (0.01 M, 1.25 mmol/h) stimulated gastric acid secretion at plasma concentrations similar to those observed after a steak meal, suggesting a physiologic role for circulating levels of these amino acids on gastric acid secretion. Because acid secretion increased at a time when serum gastrin was unchanged and since there was no correlation between changes in serum gastrin and acid secretion, the responses to phenylalanine and tryptophan are probably mediated by a nongastrin-related mechanism(s). Since both phenylalanine and tryptophan stimulated secretion in vagotomized subjects, the response is vagally independent. These observations suggest that circulating levels of these two amino acids have either a direct or indirect effect on or near the human parietal cell.
Topics: Amino Acids; Dietary Proteins; Dose-Response Relationship, Drug; Female; Gastric Acid; Gastrins; Humans; Infusions, Parenteral; Male; Phenylalanine; Tryptophan; Vagotomy; Vagotomy, Proximal Gastric
PubMed: 6853713
DOI: 10.1172/jci110875