DUODENAL INHIBITION OF GASTRIC SECRETION

The passage of the acid gastric contents into the duodenum causes an inhibition of gastric secretion. This inhibition is mediated in part at least by hormones. Pancreatic secretin and cholecystokinin have both been found to cause inhibition of food-stimulated secretion in Heidenhain pouches. Extirpation of the duodenum in whole or in part causes an increase in gastric secretion. Experimental operations such as the Exalto and Mann-Williamson procedures, which prevent the acid gastric content from entering the duodenum, cause an increase in gastric secretion through removal of the normal brake on gastric secretion exerted by the duodenum. The experimental ulcers produced by these operations are in part due to this hypersecretion. As pointed out by Poth, inadequacy of the duodenal brake on gastric secretion should be considered in relation to the cause of the hypersecretion of gastric juice in patients with ulcers. Clinical procedures such as gastroenterostomy with closure of the pylorus deviate the gastric acid from the duodenum and this is probably responsible for the disastrous results of this operation. The superiority of the Billroth I over the Billroth II operation is probably chiefly due to better preservation of the duodenal inhibition of gastric secretion. © 1969.