Forty patients after vagotomy (truncal vagotomy 18, selective vagotomy 22) with a drainage procedure were given 200 ml of 50% dextrose by mouth (dumping provocation test), the symptoms induced being noted, and any fall in plasma volume was assessed by serial measurement of the haematocrit. An insulin gastric secretion test was also performed on each patient.
Twenty of the patients had dumping symptoms of varying severity after ordinary meals: in all 20 patients these symptoms were reproduced by the dumping provocation test, which also produced similar symptoms in a further three patients.
The hydrogen ion concentration of the gastric contents was significantly lower in the basal state and after insulin hypoglycaemia in those patients with dumping symptoms than in those without such symptoms. Furthermore there was a significant inverse correlation between the hydrogen ion concentration of the gastric contents in the basal and stimulated state and the rate of plasma volume fall.
The results show that the occurrence of the dumping syndrome after vagotomy with a drainage procedure is related to the hydrogen ion concentration of the gastric contents. The possible significance of this finding is discussed.
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