Effects of selective vagotomy with or without drainage on glucose tolerance test

Abstract

Effects of selective proximal vagotomy (SPV) with pyloroplasty, SPV without a drainage, selective gastric vagotomy with antrectomy and distal gastrectomy with gastro-duodenostomy on the oral glucose tolerance test (OGTT) were studied in 25 patients with duodenal ulcer. Hyperglycemia occurred at 30 and 60 min after glucose loading and hypoglycemia occurred at 120 min in all three types of selective vagotomy. The pattern of the OGTT, however, was not remarkably changed after gastrectomy. These findings suggested that an altered pattern in the OGTT might relate to vagotomy, but not to gastrectomy or pyloroplasty. Hormonal factors, such as immunoreactive insulin (IRI), pancreatic glucagon (PG) and gut glucagon-like immunoreactivity (GLI) were measured to elucidate the mechanism of the altered patterns of OGTT after selective vagotomy. The enhanced response of IRI was found in selective vagotomy groups, in comparison with the preoperative study or gastrectomy group. The exaggerated response of IRI might the responsible for hypoglycemia. GLI and PG had little or no effect on blood glucose level on the OGTT.