Relationship between gastric acid secretion and clinical outcome after parietal cell vagotomy

Results of insulin and pentagastrin tests 2 months after parietal cell vagotomy were compared with clinical outcome in six patients with subsequent duodenal recurrence of ulcer, ten with pyloric or gastric recurrence, 43 with dyspepsia and 75 persistently symptom-free controls. The insulin-stimulated peak acid output (IPAO) and the pentagastrin-stimulated peak acid output (PAO), but not the basal acid output (BAO), were significantly higher in the duodenal recurrence group than in the controls. In the pyloric/gastric recurrence and dyspepsia groups, BAO, IPAO and PAO were similar to the control values. In the duodenal group the postvagotomy reductions of IPAO and PAO were significantly less than in the controls, indicating incomplete vagotomy. In the pyloric/gastric recurrence and dyspepsia groups, the postvagotomy BAO fall was significantly less than in the controls, but IPAO and PAO fell similarly in all three groups, indicating that pyloric or gastric recurrence was related only to inadequately reduced BAO.