Patients with duodenal ulcer are regularly found to have from 3 to 20 times the normal amount of hydrochloric acid in the fasting stomach at night. Such hypersecretion, when induced in dogs, regularly causes duodenal ulcers to form. Cutting the vagal nerve supply to the stomach reduces the fasting nocturnal secretion below the normal level. When the operation of vagotomy is combined with gastroenterostomy done in such a way as to prevent stasis of food in the pyloric antrum, the duodenal ulcers heal and remain healed. This has been demonstrated in 500 patients with duodenal ulcer. Gastric ulcer, however, most commonly arises in patients whose stomachs are atonic and display a fasting secretion less than normal. Stasis of food in the stomach causes excessive gastric secretion of humoral origin and consequent ulcer formation, while gastroenterostomy, which relieves the stasis, exerts a healing effect on gastric ulcers. Measurement of the nocturnal fasting acid secretion is therefore of great value in deciding whether the surgeon should perform vagotomy combined with antrum resection or gastric resection alone for gastric ulcers.
Dragstedt LR. CAUSE OF PEPTIC ULCER. JAMA. 1959;169(3):203–209. doi:10.1001/jama.1959.03000200001001
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