The delayed insulin test and recurrent duodenal ulceration

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Abstract
It has previously been shown that insulin tests of gastric secretion carried out within 2 weeks of vagotomy and pyloroplasty give no indication of the patient's liability to recurrent duodenal ulceration. Delayed insulin tests (done 6 or more months postoperatively) have been compared in 100 patients without and 50 patients with recurrence after operation for duodenal ulceration. Complete discrimination between the groups was not achieved but the incidence of recurrence was related to the magnitude of the acid response. As no dividing line could be established to separate tests into positive and negative results, it is preferable that the actual figures for the gastric acid response to insulin be quoted. It is suggested that the peak acid concentration should be selected for this purpose. Separate estimates of the probability of recurrence associated with various levels of peak acid concentration have been made for routine insulin tests and for tests performed in patients with clinical evidence suggestive of recurrent ulceration.