The effect of parietal cell vagotomy on gastrooesophageal function in duodenal ulcer patients

By means of a previously described method, the gastro-oesophageal region of duodenal ulcer patients was examined before and 3 months after parietal cell vagotomy. Postoperatively the patients had fewer symptoms of gastro-oesophageal reflux. The intragastric acid secretion was significantly reduced. In spite of this the oesophagus function tests used to evaluate the gastro-oesophageal region--basal gastro-oesophageal sphincter pressure, acid perfusion test, acid clearing test, and intensity of acid gastro-oesophageal reflux measured by automatic integration of the pH variations as a function of time in arbitrarily chosen pH intervals during 12 h together with peristaltic activity in the oesophagus--were unchanged. The total number of reflux episodes was unaltered, but a significant change took place postoperatively in the distribution of the reflux episodes, in the direction of reflux episodes of higher pH. A comparison preoperatively during cimetidine treatment and postoperatively showed an increase in gastro-oesophageal sphincter pressure and a reduced intensity of acid gastro-oesophageal reflux during cimetidine treatment. It is concluded that parietal cell vagotomy does not affect the gastro-oesophageal sphincter pressure, oesophageal peristaltic activity, or frequency of acid gastro-oesophageal reflux. The reduction in intragastric acid secretion causes reflux episodes of higher pH, and this in connection with healing of the ulcer explains the improvement in the symptoms of the patients.