Highly selective vagotomy and serum gastrin levels

Serum gastrin levels were measured preoperatively and at several intervals postoperatively in 262 patients who underwent highly selective vagotomy for duodenal ulcer. An increase of serum gastrin levels was demonstrated postoperatively in all patients, irrespective of sex, length of history, acid secretion data or recurrence. At several years postoperatively, a highly significant secondary rise in serum gastrin levels was observed, which corresponded well to recent physiologic and morphologic data. The most suitable explanation appeared to be that the proximal gastric vagotomy (vagotomy of the fundus and corpus) abolished the vagally mediated inhibition of the G-cells in the antrum (disinhibition of the oxyntopyloric reflex). The serum gastrin values were always higher and the secondary postoperative increase was earlier for patients who had taken cimetidine preoperatively. Contrary to traditional expectations, no correlation at all was found between serum gastrin levels and acid secretion data. Recurrence could not be predicted on the basis of serum gastrin levels.