Physiologic derangements following gastric resection

Summary and Conclusions Resection of the stomach—total, proximal, or distal—accompanied or not by vagisection, is followed by physiologic derangements which derive from mechanical and anatomic alterations, functional disorganization, and metabolic aberration. These derangements manifest themselves in various syndromes which may be grouped as: (1) deficiency syndromes, (2) cardio-respiratory syndromes, (3) syndromes of homeostatic over-reaction, and (4) syndromes reflecting discoordination of normal feedback mechanisms.Elucidation of the basic etiologic physiology has tremendously enhanced our comprehension of pathogenesis but considerable gaps in knowledge still hinder our goal of a postgastrectomy patient without dyspepsia. True, there are certain metabolic alterations which are inherent in the anatomic changes wrought by gastric surgery, but we must not be overawed by these impediments, and, above all, we must not forget that a patient exists surrounding the stomach, so that the results of gastric surgery must be profoundly influenced by extragastric and even extrasomatic or psychic factors.     

Pancreatic carcinoma following gastric resection

Summary Conclusion In this necropsy-based case-control study, there was no relationship between pancreatic carcinoma and previous gastric resection. Based on the association between lung cancer and gastric resection, it is suggested that the relationship between pancreatic carcinoma and gastric resection shown in other studies may have been confounded by smoking. Background This case-control study was designed to assess whether in patients dying from pancreatic carcinoma, there is a relationship to previous gastric resection for peptic ulcer disease. Methods By linking the autopsy data base in Malm? with the national Cause of Death Register, we identified 439 autopsied individuals who had died of pancreatic carcinoma between 1970 and 1982. The 21,660 individuals in the data base represent 64% of all deaths during that time period. For each of these individuals who died of pancreatic carcinoma, we randomly chose three controls who were matched for age at death, gender, and year of death. In order to assess the specificity of the assumed relationship, we also used as a control group the 1337 autopsied individuals who had died of lung cancer. Results The prevalence of previous gastric resections was 3.4% in patients dying from pancreatic carcinoma, 7.6% in patients dying from lung cancer, and 4.4% in the age-and sex-matched control group. The odds for previous gastric resection in patients dying from pancreatic carcinoma was 0.9 [95% confidence interval (CI) 0.5–1.7] in comparison with this age- and sex-matched control group. The lower odds for previous gastric resection in patients dying of pancreatic carcinoma than in patients dying of lung cancer remained in the logistic regression analysis after controlling for age at death, gender, and year of death (odds ratio [OR] 0.5; 95% CI 0.3–0.9).     

Enteral nutrition in malnutrition following gastric resection and cephalic pancreaticoduodenectomy.

Nutritional recovery was studied during continuous enteral nutrition in 29 patients who had developed malnutrition after gastric surgery. Patients were divided into three groups according to the type of surgery involved: total gastrectomy (n = 10), partial gastrectomy (n = 12), or cephalic pancreaticoduodenectomy (n = 7). The evolution of anthropometric and biological nutritional parameters in each group was compared with that observed in a control group of 10 nonoperated anorectic patients. Significant gains in body weight, arm muscle circumference, triceps skinfold, serum transferrin and global nutritional status were observed after 3 to 4 weeks of enteral nutrition in each group, while serum albumin, serum cholesterol, hemoglobin, and total lymphocyte count did not change significantly. No significant difference was observed between the groups. However, weight gain tended to be slower in patients with cephalic pancreaticoduodenectomy. This study confirms that enteral nutrition is an effective method of nutritional repletion after gastrectomy. Enteral nutrition can be used in undernourished gastrectomized patients when dietary measures alone have proven inadequate.     

Catamnestic findings in patients following gastric resection]

A radomized study was done in 2 groups of male patients operated upon 3-17 years ago either by partial gastrectomy (Billroth II type) or hermiotomy. The inquiries covered eating, drinking and smoking habits, occupation, body weight, subjective complaints, and use of drugs. Body weight and professional activity after operation were not different in both groups. Gastrectomized patients avoided milk or foods with milk, sweets and legumes more often. Feeling of fullness, vomiting and diarrhea occurred more frequently in gastrectomized subjects, as well as statements about good or even ravenous appetite and thirst. Gastrectomized men, besides, had a higher consumption of alcoholic drinks, preferably of beer.     

Changes in canine gastric acid output and serum gastrin levels following massive small intestinal resection.

Vagally denervated (Heidenhain) pouch acid outputs and serum gastrin concentrations, basal and in response to feeding, were measured in dogs before and after massive intestinal resection. Both 24-hr and postprandial Heidenhain pouch acid outputs increased (P less than 0.01) after intestinal resection. Increases in serum gastrin concentrations following feeding were greater after massive resection of the small intestine. There was an excellent correlation (r= 0.967; P less than 0.005) between increases in serum gastrin concentrations and Heidenhain pouch acid outputs after intestinal resection. These studies support and are consistent with the hypothesis that the polypeptide hormone gastrin plays a role in the production of the gastric acid hypersecretion which, in both dogs and man, frequently results from massive resection of the small intestine.