Abstract
Summary and Conclusions
Measurements of acid and pepsin values and determination of degree of digestion attending perfusions of the cat esophagus with gastric juice, obtained from patients after gastric resection for duodenal ulcer, have been made. These results indicate that esophageal perfusion employing the gastric juice of patients previously operated upon is a sensitive method for evaluating the likely protective effect of such operations against recurrent ulcer. Following procedures known to be associated with recurrent ulcers, gastric juice from some patients can be shown to have proteolytic digestive power not unlike that seen with untreated duodenal ulcer. After operations known from clinical experience to protect fully against recurrent ulceration, the gastric juice of patients uniformly shows acid peptic digestion in the range of normals. This technic of assessment indicates that the protection afforded by some gastric resections is inadequate and that recurrence is likely to follow. The operation affording the greatest protection is definitely the larger (85-90%) segmental resection. Lesser grades of protection appear to be provided by the smaller (40-60%) segmental resection and the Billroth II procedure. Next in line would appear to be the protection afforded by tubular resection with antral denervation. Least protection against recurrent ulcer would appear to be afforded by tubular gastric resection and the Billroth I operation.
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