COMPARISON OF ACID AND GASTRIN SECRETORY RESPONSES TO HYPOGLYCEMIA AND MEALS IN DUODENAL-ULCER WITH AND WITHOUT ACID HYPERSECRETION TO PENTAGASTRIN

In 60 uncomplicated duodenal ulcers (DU), maximum acid output (MAO) and acid output following insulin hypoglycemia (IAO) were measured, and in 30 patients also the serum gastrin responses to insulin and to standard meals. In 7 normal controls all 4 items were measured. Thirty-six of the DU had MAO within normal limits (normosecretors) and 24 were hypersecretors. Hypoglycemic vagal response was higher in all DU than in normals and was, in normosecreting DU, associated with an abnormally large functioning G cell mass. This mass is not increased in hypersecreting DU, and the greater vagal capacity is related to a supranormal parietal cell mass. An unknown mechanism, perhaps genetic, directs the trophic effects of an increased vagal drive to the gastrin cell mass in one group of DU and to the parietal cell mass in the other.