Histamine Studies in a Case of Zollinger-Ellison's Syndrome A Preliminary Report

In vivo catabolism of histamine in the human stomach

The importance of the stomach in the magnitude of excreted amounts of the major histamine metabolite in the urine was studied during total parenteral nutrition in five patients before and after total gastrectomy. In all subjects, a reduction in the 24-h urinary excretion of methylimidazoleacetic acid was observed. No corresponding effect was seen after an operation because of abdominal aortic aneurysm. In patients with duodenal ulcer disease and those submitted to a cholecystectomy because of cholecystolithiasis, we studied the catabolism of histamine in the stomach by injecting 14C-histamine directly into the portal vein and, simultaneously, 3H-histamine intra-arterially to the corpus fundus region of the stomach and subsequently determining the urinary excretion of 14C. 3H-histamine and their basic and acid metabolites, respectively. We found no apparent difference in the pattern of excreted 14C and 3H metabolites between the two patients groups, indicating that the catabolism of histamine in the stomach of patients with duodenal ulcer disease is similar to that in 'healthy' controls.

Effect of selective gastric vagotomy on histamine concentration in gastric mucosa of patients with duodenal ulcer

In a prospective controlled trial, histamine concentrations in human gastric mucosa were determined fluorometrically in 23 patients 6–11 months after selective gastric vagotomy with drainage and in patients who had undergone other types of operation for duodenal ulcer. The study was in two parts: part 1, a synchronous investigation of mucosal histamine concentrations in patients who had undergone vagotomy, in duodenal ulcer patients before operation and in control subjects; part 2, a consecutive study of the same patients before and after vagotomy.

In part 1, patients with Hollander-negative vagotomy were found to have significantly higher mucosal histamine concentrations than ‘healthy’ control subjects or duodenal ulcer, however, had as low mucosal histamine concentrations as duodenal ulcer patients who had not been operated on. In part 2, all duodenal ulcer patients showed an increase in gastric mucosal histamine concentration after vagotomy (P < 0·01). The smallest increase was in a patient with an incomplete vagotomy. Control patients who were not operated on but who underwent endoscopy and biopsy twice in the period of investigation, did not show any increase in mucosal histamine concentration between the times of the first and the second biopsy. The overall results of selective vagotomy and drainage in this study, with respect both to clinical Visick gradings and to radiological and acid secretory findings, were comparable to those reported by other authors. No significant change in numbers of parietal cells was found after vagotomy. Thus, selective gastric vagotomy with a drainage procedure leads to increased concentrations of histamine in the mucosa of the body of the stomach in man. The mechanism is not clear, but might be through inhibition of histamine release from mast cell stores.