The Effect of Vagotomy and Antrectomy on Serum Pepsinogens I and II

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Abstract
Ninety-seven consecutive patients with gastric surgery for peptic ulcer were studied; 86 had duodenal ulcer (DU), and 11 gastric ulcer (GU). DU patients were surgically treated by proximal vagotomy, proximal vagotomy and pyloroplasty, truncal vagotomy and pyloroplasty, or truncal vagotomy and antrectomy. All GU patients were operated on by the Billroth I method. Serum pepsinogen I (S-PG I), serum pepsinogen II (S-PG II), basal acid output (BAO), and maximal acid output (MAO) were determined before and 3 months and 1 year after the operation. The mean preoperative S-PG I concentration in DU patients (154 ± 7 μg/1; mean ± SE) was significantly higher than that (97 ± 9 μg/1) in GU patients (p < 0.001). A significant decrease in the mean S-PG I concentration in DU patients was seen 3 months (92 ± 6 μg/1) and 1 year (66 ± 4 μg/1) after the operation (p < 0.001). This change did not depend on the type of vagotomy. However, this decrease was not seen in all individual patients as it was in BAO values. Moreover, the mean BAO decrease was much greater at 3 months (7% of the preoperative value) and 1 year (23%) after the operation than the respective decrease in S-PG I concentration. There was also no correlation between S-PG I and acid output (BAO and MAO) before and after the operation. In GU patients the decrease in mean S-PG I value after the Billroth I operation was smaller than in DU patients after vagotomy. Preoperatively, the mean S-PG II did not differ significantly between DU and GU patients. It tended to decrease after the operation in both groups, but the decrease was not statistically significant. Antrectomy had no significant effect on S-PG II level, which indicates that the contribution of the antrum to the total pool of PG II is small. Patients with superficial gastritis in the gastric body mucosa tended to have higher serum pepsinogen levels than patients with normal gastric body mucosa. The mean preoperative serum PG I/PG II ratio was 10.4 ± 0.5 in DU patients and 6.8 ± 1 in GU patients (p < 0.001). A significant decrease in the serum PG I/PG II ratio was found in all patient groups 1 year after the operation. The mean preoperative S-PG I- S-PG II difference was 136 ± 7 μg/1 in DU patients and 77.8 ± 7 μg/1 in GU patients (p < 0.01). The S-PG I-S-PG II difference showed the most marked postoperative decrease of all pepsinogen variables measured in this study. This study indicates that the correlation between serum pepsinogen levels and acid secretion variables is poor, and that acid secretion studies are superior in the evaluation of the gastric secretion status before and after different types of gastric surgery in patients with peptic ulcer.