Abstract
The studies on gastric secretion to be reported in this paper were performed on 19 patients with duodenal ulcers both before and after division of all vagus fibers to the stomach. The nerves were divided just above the diaphragm by a method previously described. 1 Observations have been made on the continuous night secretion of gastric juice, and the secretory response to histamine, caffeine, insulin, and sham feeding.
a. Continuous Night Secretion. There are surprisingly few data on the secretion of the empty stomach of ulcer patients in the absence of any known gastric stimulant. The studies embodied in this report were made as follows: At 9:00 p.m. the stomach was emptied and lavaged with an Ewald tube. When the returns were clear, a Levine tube was introduced through the nose into the stomach and continuous suction maintained until 9:00 a.m. with the Wangensteen apparatus. In 9 patients with carcinoma of the stomach an average of 261 cc of secretion was obtained with a free acidity between 0 and 21 clinical units. In 5 patients with carcinoma of the colon an average of 238 cc was obtained with a free acidity between 0 and 18 clinical units. In 6 patients with gall stones an average of 385 cc of secretion was obtained with a free acidity of 0 to 13 clinical units. In contrast to these findings in 19 patients with duodenal ulcer the night secretion averaged 820 cc with a free acidity between 24 and 82 clinical units. After recovery from the operation for division of the vagus nerves, the ulcer patients secreted an average of 415 cc with a free acidity between O and 61 clinical units. These observations indicate an abnormally large secretion of gastric juice commonly occurs in the empty stomach of ulcer patients in the absence of any of the usual types of secretory stimuli and that this excessive secretion is neurogenic in origin.
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