Glucose inhibited acid secretion of the stomach in patients with duodenal ulcer, and prolonged gastric emptying time. The maximal effect was produced by intraduodenal hypertonic glucose, oral and intravenous glucose having a similar but weaker action.The inhibition of gastric acidity produced by intraduodenal hypertonic glucose in patients with duodenal ulcer was not so complete as that produced in normal persons.Insulin stimulated acid secretion of the stomach in patients with duodenal ulcer and shortened gastric emptying time. This action was more powerful in patients with duodenal ulcer than in normal persons.Thirteen patients with duodenal ulcer out of 80 investigated had a‘lag curve’type of response to the ingestion of 50 gm. glucose. Six of them developed confirmed hypoglycaemic symptoms during the test.In 87 patients with duodenal ulcer, blood-sugar estimations made during attacks of ulcer pain showed constant hypoglycaemic levels in four patients, variable levels in eight, and levels invariably above 70 mg. per 100 c.c. in 75.It is suggested that hypoglycaemic pain is a clinical entity in duodenal ulcer. Four patients were found who suffered exclusively from it, and six who had it as an occasional symptom.Hypoglycaemic pain is contrasted with the common type of ulcer pain and found to differ from it, mainly in its association with intense hunger and other hypoglycaemic symptoms.Four patients with chronic duodenal ulcer are described, each of whom gave a history of repeated attacks of alimentary hypoglycaemia as their major complaint.Glucose was found to be ineffective in relieving the common type of ulcer pain. It relieved hypoglycaemic pain immediately.It is suggested that intraduodenal hypertonic glucose has a place in the treatment of intractable cases of peptic ulcer.My thanks are due to Dr. D. K. Adams and Professor C. F. Illingworth in whose departments of the Western Infirmary, Glasgow, the work was carried out, and principally to Professor J. W. McNee for his help and encouragement in the preparation of this paper, and for laboratory facilities in the Gardiner Institute of Medicine.The work was carried out during the tenure of a British Medical Association Research Scholars
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