Pancreatic polypeptide. Release following surgery for duodenal ulcer disease

The pancreatic polypeptide (PP) response to food has been measured by radioimmunoassay in patients with duodenal ulcer and 3 months following proximal gastric vagotomy (PGV), 18 and 49 months following truncal vagotomy and pyloroplasty (TV), 35 months following Billroth II gastrectomy (BII), and 35 months following truncal vagotomy and antrectomy (TV&A). Basal PP levels and those in response to food were similar in DU and PGV, but these values were significantly higher than those 18 months or 49 months after TV, or after BII and TV&A. The responses in the latter four groups were similar and in particular, the levels 18 and 49 months after TV were the same. These results indicate that the release of PP by food in unoperated patients consists of two phases, a primary phase which requires both intact vagi and an intact stomach and a secondary phase which also depends on vagal innervation and normal gastric anatomy. Disturbances in vagal innervation or gastric integrity lead to profound changes in PP release which may be due to interruption of neural arcs or loss of gastric hormones. Unlike others, we have been unable to document a return of PP secretion towards normality with time after TV.