Biopsy specimens have been taken from five standard sites in the stomach and from the duodenal bulb in order to investigate the association of
gastritis and
duodenitis with
duodenal ulcer. Twenty patients with chronic
duodenal ulcer were investigated in this manner and in addition had gastric secretion tests and a radio-immune assay of serum
gastrin under differing conditions. The patients were then treated either by a
truncal vagotomy and pyloroplasty (TVP) or by a
highly selective vagotomy without a drainage procedure (HSV). All the investigations were repeated three months postoperatively.
Duodenal ulcer was usually associated with gastriitis, although this varied in extent and severity from patient to patient. In nearly all the patients,
gastritis was present at the pyloric end of the stomach and along the lesser curve. In more than half of the patients,
gastritis was also present in the body of the stomach but the fundus was usually spared. Chronic
duodenitis was found in the duodenal bulb in all these patients. After
vagotomy there was a marked increase in both the extent and severity of the proximal
gastritis in both treatment groups but the distal
gastritis remain almost unchanged. There was little change in the incidence of
duodenitis after
vagotomy but its severity was lessened. No correlation was found between the peak
acid output (PAO) in response to
Histalog and the severity of the
gastritis or the
duodenitis either before or after operation, with one exception. The postoperative PAO was significantly less in those patients who developed a severe proximal
gastritis after
vagotomy. No relationship was found between the severity of the distal
gastritis and the levels of serum
gastrin. No correlation was found between either the basal or peak
acid output and the corresponding serum
gastrin levels before or after
vagotomy.