Effect of proximal gastric vagotomy on insulin- induced gastric H+ and pepsin secretion and serum group I pepsinogens.

The effect of insulin-induced hypoglycemia on serum group I pepsinogens (PG I), gastric H+, and pepsin secretion was studied in 11 duodenal ulcer patients before and 30 days after a proximal gastric vagotomy. The hypoglycemia elicited a significant increase in all the three variables preoperatively but in none of them postoperatively. This suggests that the preoperative increase in serum PG I must be mediated by the vagal nerves. Four of the 11 patients had an incomplete vagotomy by the method of Hollander. Serum PG I did not show any rising tendency in these patients postoperatively. It seems that serum PG I is a less sensitive indicator of the "completeness" of vagotomy than gastric H+ output. The serum PG I response to insulin-induced hypoglycemia can accordingly not be used as a clinical test for completeness of vagotomy.