Supra-Diaphragmatic Section of the Vagus Nerves in Treatment of Duodenal Ulcer. ∗

Abstract

Much of the experimental work on the pathogenesis of gastroduodenal ulcer that has appeared in recent years is in harmony with the concept that the cause of these ulcers is the corrosive action of the gastric juice. It has been adequately demonstrated that pure gastric juice can destroy and digest living tissues including the wall of the stomach itself, producing in this case a defect which appears to be identical with the lesion encountered in man. 1 Under normal conditions, the gastric wall is not digested away apparently because it is not exposed to pure gastric juice. Food, which in the normal individual is the stimulus for the formation of gastric juice, is also the chief factor which protects the tissues against its corrosive activity. Pancreatic juice, gastric and intestinal mucus, duodenal juice and bile (probably in the order named) constitute an additional mechanism which protects the duodenal and, to a certain extent, also the gastric and the jejunal mucosa. When excessive volumes of normal gastric juice are continuously secreted in experimental animals, this defensive neutralizing mechanism is overcome, and ulcer is produced. Wangensteen and his associates 2 have produced ulcers in many experimental animals by the implantation of pellets of histamine mixed with beeswax into the muscles or beneath the skin. The gradual liberation of histamine provoked a long continued secretion of gastric juice. Most ulcer patients display an excessive secretion of gastric juice in response to the stimulus of food, histamine, or alcohol. A considerable number secrete large amounts of gastric juice when there is no obvious stimulant, as at night when the stomach has been previously emptied of food by lavage. The cause of this abnormal secretion is unknown.