The acid secretory response to betazole and insulin hypoglycemia after selective proximal vagotomy for duodenal ulcer.

ABSTRACT

In order to assess the result of vagotomy an insulin test is usually performed postoperatively. The insulin test, however, is associated with troublesome side-effects and potentially dangerous. Also its prognostic value as regards ulcer recurrence is doubtful. In this follow-up study of 118 patients, who had selective proximal vagotomy (SPV) performed for duodenal ulcer between 1968 and 1971, the insulin test is compared with a postoperative betazole (Histalog) test. Both tests were carried out 1-3 months after SPV. The insulin tests were classified according to Hollander. For the betazole tests the following criteria were used the test was classified as negative if the reduction in peak acid output (PAOB) exceeded 50% or if the postoperative PAOB-value was lower than 15 mmol/h irrespective of the preoperative value. Values outside these were considered positive. At the follow-up 5-9 years after surgery, a total of 17 recurrent ulcers were diagnosed. The sensitivity and the specificity - i.e. the percentage of patients with recurrent ulceration and positive criteria respectively patients without recurrent ulcer and negative criteria - were calculated for the tests. Thus, the sensitivity and specificity for the insulin tests were found to be 53% and 84% respectively and for the betazole tests 59% and 91% respectively. The difference is thus very small and it seems that a postoperative test with a non-vagal gastric stimulant gives as good prognostic information as an insulin test after selective proximal vagotomy. However, both tests give a low sensitivity (53% resp. 59%) and therefore the prognostic value regarding ulcer recurrence is doubtful.