Abstract
Studies in animals and man suggest involvement of the vagal nerve in the pathophysiology of massive obesity. An abnormal vagal response pattern has been found in the obese rat, but corresponding functional studies in obese man are nonexistent. The gastric acid secretion was therefore examined in 13 nondiabetic grossly obese patients (average body weight 120 kg) and compared to 16 age-matched controls of normal body weight. The gastric acid response to modified sham feeding was significantly (P<0.05) reduced in obese patients, being on average 60% of the control output. The obese patients had a higher maximal gastric acid response to graded intravenus pentagastrin, 36.6±2.9 mmol/hr, compared to 27.1±2.4 mmol/hr in controls (P<0.05). In addition, the patients seemed to need less pentagastrin to reach a secretory plateau. Basal acid secretion rates were similar in obese and control groups. Plasma gastrin and blood glucose were not significantly different in obese patients and controls, but patients had significantly elevated plasma insulin levels. The change of plasma insulin during the sham-feeding procedure correlated with the magnitude of the secretory response in obese and control subjects. The reduced gastric acid response to vagal stimulation in the absence of impaired parietal cell function in obese patients is indicative of an association between massive obesity and altered vagal function in man.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Kral JG: Vagotomy as a treatment for morbid obesity. Surg Clin North Am 59(6):1131–1138, 1979
Powley TL, Opsahl CA: Ventromedial hypothalamic obesity abolished by subdiaphragmatic vagotomy. Am J Physiol 226:25–33, 1974
Mordes JP, Herrera MG, Silen, W: Decreased weight gain and food intake in vagotomized rats. Proc Soc Exp Biol Med 156:257–260, 1977
Inoue S, Bray GA: The effects of subdiaphragmatic vagotomy in rats with ventromedial hypothalamic obesity. Endocrinology 100:108–114, 1977
Ridley PT, Brooks FP: Alterations in gastric secretion following hypothalamic lesions producing hyperphagia. Am J Physiol 209:319–323, 1965
Schachter S: Some extraordinary facts about obese humans and rats. Am Psychol 26:129–144, 1971
Larsson LEI: Nonlabeled vitamin B12 as a dilution indicator in gastrointestinal research. J Clin Invest 18:535–539, 1966
Hydén S: The recovery of polyethylene glycol after passage through the digestive tract. Intest Anim Physiol 22:411–424, 1955
Hjelm M, de Verdier CH: A methodological study of the enzymatic determination of glucose in blood. Scand J Clin Lab Invest 15:415–428, 1963
Nilsson G: Increased plasma gastrin levels in connection with inhibition of gastric acid responses to sham feeding following bulbar perfusion with acid in dogs. Scand J Gastroenterol 10:273–277, 1975
Herbert V, Lan KS, Gottlieb CW, Bleicher SY: Coated charcoal immunoassay of insulin. J Clin Endocrinol Metab 25:1375–1384, 1965
Card WI, Marks IN: The relationship between the acid output of the stomach following “maximal” histamine stimulation and the parietal cell mass. Clin Sci 19:147–154, 1960
Flemström G: Active alkalinisation by amphibian gastric fundic mucosa in vitro. Am J Physiol 233(1):E1-E12, 1977
MacGregor IL, Deveney C, Way LW, Meyer JH: The effect of acute hyperglycemia on meal-stimulated gastric, biliary and pancreatic secretion and serum gastrin. Gastroenterology 70:197–202, 1976
Moore JG, Crespin F: Influence of glucose on cephalicvagal-stimulated gastric acid secretion in man. Dig Dis Sci 25:117–122, 1980
Sims EAH, Danforth E, Horton ES, Bray GA, Glennon JA, Salans LB: Endocrine and metabolic effects of experimental obesity in man. Recent Prog Horm Res 29:457–487, 1973
Bagdade JD, Bierman EL, Porte D: The significance of basal insulin levels in the evaluation of the insulin response to glucose in diabetic and nondiabetic subjects. J Clin Invest 46:1549–1557, 1967
Karam JH, Grodsky GM, Forsham PH: Excessive insulin response to glucose in obese subjects as measured by immunochemical assay. Diabetes 12:197–204, 1963
Sjöström L, Garellick G, Krotkiewski M, Luyckx A: Peripheral insulin in response to the sight and smell of food. Metabolism 29:901–909, 1980
Hesselfeldt P, Christiansen J, Rehfeld JF, Backer O: Meal-stimulated gastric acid and gastrin secretion before and after jejuno-ileal shunt operation in obese patients. A preliminary report. Scand J Gastroenterol 14:13–16, 1979
Barry RE, Barisch J, Bray GA, Sperling MA, Morin RJ, Benfield J: Intestinal adaptation after jejunoileal bypass in man. Am J Clin Nutr 30:32–42, 1977
Mason EE, Munns JR, Kealey GP, Wangler R, Clarke WR, Cheng HF, Printen KJ: Effect of gastric bypass on gastric secretion. Am J Surg 131:162–168, 1976
Malfertheiner P, Wechsler JG, Ditschuneit HH, Ditschuneit H: Magen- und Parotissekretion bei Adipositas. Z Gastroenterol 19:261–266, 1981
Bray GA: Hypothalamic and genetic obesity: An appraisal of the autonomic hypothesis and the endocrine hypothesis. Int J Obes 8(Suppl 1):119–137, 1984
Author information
Authors and Affiliations
Additional information
This study was supported by a grant from the Karolinska Institute, Stockholm and Swedish Medical Research Council 19x-00580 and 19x-7457.
Rights and permissions
About this article
Cite this article
Wisén, O., Rössner, S. & Johansson, C. Gastric secretion in massive obesity. Digest Dis Sci 32, 968–972 (1987). https://doi.org/10.1007/BF01297185
Received:
Revised:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF01297185