Relationship between gastric acid secretion and the rate of recurrent ulcer after parietal cell vagotomy

This study assessed the effect of gastric secretion on the rate of recurrent ulcer after parietal cell vagotomy for duodenal ulcer. Three hundred patients who underwent parietal cell vagotomy for duodenal ulcer between 1975 and 1986 were evaluated. The mean follow-up period for 280 patients was 5 years. The gastric secretion tests concerned basal acid output (BAO) and peak acid output stimulated by pentagastrin or insulin. Tests were preoperative for 172 patients and postoperative for 118. At the end of that time, the overall incidence of symptomatic recurrent ulcer was 15%. Two criteria were shown to be important predictors of recurrent ulcer: preoperative BAO > 7 mmol/hr, for which the recurrence rate 5 years after vagotomy was 30% versus 11% for values below this threshold (p = 0.01), and postoperative BAO > 1.4 mmol/hr, for which the recurrence rate at 5 years was 72% versus 8% for lower values (p = 0.0001). All patients with recurrent ulcer had either a postoperative BAO > 7 mmol/hr and/or a postoperative reduction in BAO < 80%. Preoperative BAO > 7 mmol/hr and postoperative BAO > 1.4 mmol/hr were shown to be factors predictive of RU. All patients with RU presented either with preoperative BAO > 7 mmol/hr and/or a reduction in BAO < 80%. Consequently, in our opinion, these criteria could be used either to select patients for vagotomy or to assess the effectiveness of vagotomy of different types, especially those performed by celioscopy.