[Congo red test with insulin stimulation for the evaluation of vagal integrity after vagotomy].
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Biomedical subjects
Publications and source records attributed to J E Künzle.
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In the present study, the completeness of vagotomy in patients who underwent truncal and highly selective vagotomy is evaluated, comparing them with control groups of normal persons and patients with a duodenal ulcer. The evaluation was made by the Hollander test, followed by the endoscopic Congo red test, using the same hypoglycemic stimulus. Gastric acid production was higher in the patients with duodenal ulcer, followed by the normal persons. Lower acidity levels were obtained for patients with truncal vagotomy than for patients with highly selective vagotomy. During the Congo red test, we noted that the patients with truncal or highly selective vagotomy had small black spots in the gastric mucosa, except those having a recurrent ulcer, denoting incomplete vagotomy. Nevertheless, when we observed the appearance of the gastric mucosa, we noted a similar aspect for those having had a vagotomy and for normal persons. This appearance was completely different from the patients with a duodenal ulcer. We concluded that truncal vagotomy greatly reduces the level of gastric acid production, while highly selective vagotomy does so to a lesser extent. The endoscopic aspect of these patients during the Congo red test was similar to that for normal persons.
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BACKGROUND/AIMS: The role of Helicobacter pylori as a cause of peptic ulcer is still subject to controversy. The Kock's postulates have not been yet fulfilled; the bacteria can be found in normal persons, and it persists in the stomach after the ulcer is healed. MATERIAL AND METHODS: The authors analyzed 41 persons formerly submitted to surgery (after 8 years and 4 months, as a mean), 31 to highly selective vagotomy, and 10 to truncal or selective vagotomy plus gastroduodenal drainage. All of them were asymptomatic, or had symptoms not related to ulcer relapse. RESULTS: At endoscopy the ulcers were healed in all 41 individuals, and there was evidence of gastritis in three. The histopathological exam showed gastritis in all biopsy specimens. The search of H. pylori by urease method and by Giemsa staining was positive in 40. CONCLUSION: It was concluded that the gastric acid secretion reduced by vagotomy was the main factor to healing the ulcer, not subordinated to H. pylori.