Bombesin and insulin-stimulated pancreatic polypeptide release as a discriminator of vagal integrity

Abstract

Intact vagi after ulcer operations are often implicated in the cause of recurrent ulcer. The stimulation of gastric acid by insulin hypoglycemia is dangerous and the measurement of acid secretion after gastrectomy unreliable. This study was undertaken to assess and compare PP release by bombesin or insulin as an indicator of vagal integrity. Eight dogs with a chronic gastric fistula were tested with bombesin (100 nanograms per kilogram) and insulin (0.1 unit per kilogram) intravenous bolus after unilateral and, then, bilateral truncal vagotomy. Each study was 120 minutes, and blood was taken at one, three, five, seven and then ten minute intervals. Gastric acid was measured by autobiuret titration. Plasma was stored at minus 20 degrees C. until assayed for PP by radioimmunoassay. Bombesin-stimulated gastric acid secretion was not significantly altered by vagotomy (p greater than 0.05), whereas that stimulated by insulin was significantly inhibited by bilateral truncal vagotomy (p less than 0.05). Bilateral and right hemivagotomy significantly inhibited PP release by bombesin (p less than 0.05), however, only bilateral truncal vagotomy significantly inhibited PP release by insulin (p less than 0.05). These results suggest that the measurement of PP release by insulin or bombesin is a sensitive index of vagal integrity and that bombesin-released PP may specifically delineate the integrity of the right vagus. Since the measurement of gastric acid secretion after operation is both uncomfortable and often difficult to interpret, the value of a simple blood test to determine vagal integrity may be of considerable clinical relevance.