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The AntrumIts Role in the Surgery of Duodenal Ulcer
NILES D. CHAPMAN, M.D.;
HENRY N. HARKINS, M.D.;
LLOYD M. NYHUS, M.D.
AMA Arch Surg. 1960;81(4):517-524.
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Because the antrum is the source of the acid secretion stimulating hormone gastrin, it has been believed that a successful operation for duodenal ulcer includes removal of the antrum. Contrary to this view, we now know that the antrum can be retained, provided certain criteria are followed.
If the antrum is retained, it must
( 1 ) be vagally denervated;
(2) remain in the acid stream;
(3) have antral stasis prevented.
The experimental basis for these criteria will be presented together with a brief review of the effect of various surgical procedures upon the antrum (Fig. 1).
Experimental Normal Mechanisms of Gastric Acid Secretion
A. Antral Stimulatory Mechanisms for Gastrin Release
Edkins in 1906 demonstrated that the antral mucosa contained a hormone (gastrin) which, when injected intravenously, produced a copious secretion of HCl from a denervated stomach.
Gastrin is released from the antrum in response to specific stimuli, which are:
(1) Vagal:
. . . [Full Text PDF of this Article]
Author Affiliations
Seattle
From the Department of Surgery, University of Washington School of Medicine.; Fellow, National Institutes of Health (Dr. Chapman); Professor and Executive Officer, Department of Surgery (Dr. Harkins), Associate Professor, Department of Surgery (Dr. Nyhus), University of Washington School of Medicine.
Footnotes
Submitted for publication Dec. 4, 1959.
Supported by Grants-In-Aid from the National Institutes of Health.
Surgery Illustrated. Shown as a scientific exhibit at the 45th Clinical Congress of the American College of Surgeons in Atlantic City, N.J., Sept. 28-Oct. 2, 1959.
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