Recurrent ulceration after proximal gastric vagotomy. Possible role of mucosal barrier

Between 1971 and 1986 532 proximal gastric vagotomies were carried out at the Pelgulinna Hospital. The five-year recurrence rate was 5.5% (n = 29). We have studied 40 patients with chronic duodenal ulceration, 20 patients who had effective proximal gastric vagotomy, and seven patients who presented with recurrent ulcers after proximal gastric vagotomy. Patients who had positive Hollander tests after vagotomy, and those with disorders of gastric motility, were excluded. In the group with recurrent ulcers the concentration of neutral mucopolysaccharides in the gastric juice was significantly lower than in the other two groups, and it correlated with the amount of material showing a positive reaction to periodic acid Schiff (PAS) in the gastric mucosa. This group also had significantly higher mean serum gastrin concentrations and mast cell degranulation rates in the mucosa of the fundus and the antrum. We conclude that qualitative changes in the production of gastric mucus lead to defective functioning of the mucosal barrier in patients with recurrent ulcers and may be one of the causes of recurrences.