Gastrojejunostomy has failed as a treatment for active duodenal ulcer disease because of a very high relapse rate. The reasons for its failure have been clarified by experimental studies demonstrating that gastrojejunostomy increases, rather than decreases, the gastric secretion of hydrochloric acid.
These studies are best understood if the secretory responses to gastrojejunostomy are considered in terms of known mechanisms of normal gastric secretion.
I. Normal Mechanisms of Gastric Acid Secretion
Physiologist and clinicians generally accept the concept that peptic ulceration is dependent upon excess free hydrochloric acid, for only at very acid pH can peptic digestion take place. The control of acid secretion has been so extensively investigated that a comprehensive review is not possible here. A few specific experiments, however, have contributed the framework for our understanding of the physiology of gastric acid secretion.
A. The Antral Phase of Acid Secretion.
This has also been termed the chemical,