Pepsin and acid secretions during and after gastric operations in patients with duodenal ulcer.Can J Surg. 1977 May; 20(3):239-41,243.CJ
Measurement of gastric pepsin and acid secretion was performed before, during and after selective vagotomy with antrectomy (SVA) and Billroth I gastrectomy (B-I) in 20 patients with a duodenal ulcer. Preoperative pepsin concentration increased during operation and decreased gradually 72 hours after SVA and 1 to 3 months after B-I. Although the pepsin concentration decreased substantially, it was never less than 70% of the preoperative level in both groups. Acid concentration decreased immediately after vagotomy in the SVA group and decreased gradually after 72 hours in the B-I group. Although there was a notable increase in the pH in both groups after operation, a pH of 5 was never reached. Decrease in gastric secretory volume (about 50%) was approximately equal in both groups. It appears that any increase in acid secretion occurring after vagotomy or gastrectomy may be sufficient to activate high-and low-pH-acting pepsins. Extravagal and extraantral stimulation of gastric pepsin secretion after operation should be considered an important etiologic factor in the pathogenesis of recurrent ulcer.