One of the fundamental principles underlying the treatment of peptic ulcers is an attempt to control gastric acidity. This idea is based on the assumption that the presence of hydrochloric acid is an important contributory factor in the etiology of ulcers.1 As a result, various surgical measures are employed to reduce the acidity of the gastric contents. Simple procedures, such as gastro-enterostomy2 and pyloroplasty,3 afford only a temporary neutralization of gastric acidity and the development of recurrences and jejunal ulcers after these operations is attributed largely to the persistence of hyperchlorhydria. In order to achieve more lasting cures subtotal gastrectomy is advocated4 as a method which provides for a permanent lowering of gastric acidity by interfering with the normal mechanism of acid secretion.
According to the present concept of the physiology of the stomach, acid is secreted normally in four phases. The first is the cephalic
SHAPIRO PF, BERG BN. RETURN OF GASTRIC ACIDITY AFTER SUBTOTAL GASTRECTOMY AND DOUBLE VAGOTOMY. Arch Surg. 1934;28(1):160–179. doi:10.1001/archsurg.1934.01170130163010
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