Gastric acid secretion stimulated by modified sham-feeding, and the effects of histamine H2-antagonist and anti-muscarinic agent in patients with duodenal ulcer.
Patients with duodenal ulcer (DU) were classified into responders to H2-antagonist and non-responders in whom DU did not heal within 3 months with the antagonist. In these patients and healthy controls, a modified sham-feeding (MSF) test was performed to elucidate the pathogenesis of resistance to H2-antagonist. By MSF stimulation, gastric acid secretion significantly increased in all subjects. The mean acid output by MSF amounted to about 52 of the tetra-gastrin maximum in controls (12 cases), 46% in responders (12 cases) and 72% in non-responders (14 cases). The mean acid output in non-responders was significantly higher than in controls under baseline conditions, MSF and gastrin stimulations, but was higher than in responders during MSF stimulation. The effects of H2-antagonist (cimetidine 1mg/kg/h), anti-muscarinic agent (pirenzepine 0.3mg/kg/h), or both on the acid secretion were examined on non-responders (6 cases), responders (6 cases) and healthy controls (6 cases). The acid secretion stimulated by MSF was significantly inhibited by pirenzepine in responders and controls, but not in non-responders. With cimetidine, the acid output was significantly inhibited in all groups, but was still higher in non-responders than in controls and responders, indicating that the reduction of acid output by a H2-antagonist is significantly less in non-responders than in other groups. The combined use of pirenzepine and cimetidine almost completely inhibited the acid output in all groups. These data suggest that the vagal activity in non-responders to H2-antagonist is higher than in responders and healthy subjects, and H2-antagonist combined with anti-muscarinic agent is more effective in reducing the gastric acid secretion in non-responders.
Ooi
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S
First Department of Medicine, Hamamatsu University School of Medicine, Japan.
Kaneko
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E
D000328:Adult; D002927:Cimetidine / Q000494:pharmacology; D004381:Duodenal Ulcer / Q000378:metabolism*; D005744:Gastric Acid / Q000378:metabolism*; D006635:Histamine H2 Antagonists / Q000494:pharmacology*; D006801:Humans; D008875:Middle Aged; D009116:Muscarine / Q000037:antagonists & inhibitors*; D010890:Pirenzepine / Q000494:pharmacology; D012016:Reference Values
D006635:Histamine H2 Antagonists; D010890:Pirenzepine; D009116:Muscarine; D002927:Cimetidine