title: The gastric mucosa 25 years after proximal gastric vagotomy.
abstract: OBJECTIVE
  Vagotomy causes inhibition of basal and post-prandial acid secretion in humans, but the knowledge about the trophic effect of the vagal nerves is limited. Vagotomy is known to induce hypergastrinemia and we aimed to study the long-term effects of proximal gastric vagotomy (PGV) on the oxyntic mucosa and the enterochromaffin-like (ECL) cell density in particular.
  
  
  METHODS
  Eleven patients operated with PGV because of duodenal ulcer and age- and sex-matched controls were examined 26 to 29 years postoperatively by gastroscopy with biopsies from the antrum and oxyntic mucosa. Neuroendocrine cell volume densities were calculated after immunohistochemical labeling of gastrin, the general neuroendocrine cell marker chromogranin A (CgA) and the ECL cell marker vesicular monoamine transporter 2 (VMAT2). Gastritis was graded and Helicobacter pylori (H. pylori) status was determined by polymerase chain reaction of gastric biopsies. Fasting serum gastrin and CgA were measured.
  
  
  RESULTS
  Serum gastrin was higher in the PGV group compared to controls (median 21.0 [interquartile range (IQR) = 22.0] pmol/L vs 13.0 [IQR = 4.0] pmol/L, p = 0.04). However, there was neither a significant difference in serum CgA or in CgA (neuroendocrine) nor VMAT2 (ECL cell) immunoreactive cell volume density in the oxyntic mucosa. There was significantly more inflammation and atrophy in H. pylori-positive patients, but PGV did not influence the grade of gastritis.
  
  
  CONCLUSIONS
  Despite higher serum gastrin concentrations, patients operated with PGV did not have higher ECL cell mass or serum CgA. Vagotomy may prevent the development of ECL cell hyperplasia caused by a moderate hypergastrinemia.
authors.affiliation: Department of Gastroenterology and Hepatology, St Olavs Hospital , Trondheim , Norway.
authors.forename: Liv
authors.initials: L
authors.lastname: Sagatun
authors.forename: Constantin S
authors.initials: CS
authors.lastname: Jianu
authors.forename: Reidar
authors.initials: R
authors.lastname: Fossmark
authors.forename: Ronald
authors.initials: R
authors.lastname: Mårvik
authors.forename: Ivar S
authors.initials: IS
authors.lastname: Nordrum
authors.forename: Helge L
authors.initials: HL
authors.lastname: Waldum
mesh_terms: D000368:Aged; D001706:Biopsy; D053379:Chromogranin A / Q000032:analysis; D004381:Duodenal Ulcer / Q000601:surgery; D019861:Enterochromaffin-like Cells / Q000737:chemistry / Q000473:pathology*; D005260:Female; D005500:Follow-Up Studies; D005744:Gastric Acid / Q000378:metabolism*; D005753:Gastric Mucosa / Q000737:chemistry / Q000473:pathology*; D005755:Gastrins / Q000097:blood; D005757:Gastritis, Atrophic / Q000473:pathology; D005773:Gastroscopy; D016481:Helicobacter Infections / Q000473:pathology*; D016480:Helicobacter pylori; D006801:Humans; D008297:Male; D008875:Middle Aged; D011706:Pyloric Antrum / Q000737:chemistry / Q000473:pathology*; D013997:Time Factors; D014629:Vagotomy, Proximal Gastric; D050493:Vesicular Monoamine Transport Proteins / Q000032:analysis
chemical_list: D053379:Chromogranin A; D005755:Gastrins; C493452:SLC18A2 protein, human; D050493:Vesicular Monoamine Transport Proteins
keywords: chromogranin A; enterochromaffin-like cell; gastrin; vagotomy; vagus