Gastric pepsin and acid secretion following various operations for gastric and duodenal ulcer.

In 117 cases of gastric and duodenal ulcer subjected to various types of operation, insulin- and histamine-stimulated secretion of gastric pepsin and acid was investigated at follow-up. Secretory responses of gastric pepsin to the stimulation with insulin and histamine were different from those of gastric acid. Insulin was confirmed to have a greater ability than histamine to stimulate gastric pepsin secretion. In the cases of vagotomy with pyloroplasty and those of vagotomy with hemigastrectomy, the average reduction rates of peak pepsin output were 80% and 92%, respectively, after insulin-stimulation, and 52% and 74% after histamine-stimulation. In view of gastric pepsin secretion, pylorus-preserving gastrectomy and segmental gastrectomy are more physiological than distal gastrectomy.