The effect of pancreatic fistula on gastric secretion.

Zollinger and Ellison first called attention to instances of recurrent peptic ulceration associated with islet cell tumors of the pancreas. 1 These were characterized by hyperacidity and hypersecretion of acid gastric juice and not controlled by vagotomy and extensive gastric resection. Previous experimental studies have also demonstrated an interrelationship between the pancreas and gastric secretion. Dragstedt reported in 1942 that approximately 100% of dogs with external total pancreatic fistulae developed duodenal ulcer, whereas dogs in whom the pancreatic ducts had been ligated had only a 29% incidence of duodenal ulcer. He further found that dogs upon whom a pancreatectomy had been performed developed ulcer in only 1%-3%. 2 In all three of these preparations the external secretion of the pancreas is absent from the duodenum. The internal drainage of bile and pancreatic juice to the terminal ileum in the Mann-Williamson dog also results in a high incidence of peptic ulceration.