Stasis syndromes following gastric surgery: Clinical and motility features of 60 symptomatic patients

Alexander Fich, Matteo Neri, Michael Camilleri, Keith A. Kelly, Sidney F. Phillips

Research output: Contribution to journalArticle

58 Scopus citations

Abstract

We retrospectively reviewed the records of 60 patients who had been referred for gastrointestinal manometry because of stasis after gastric surgery. Nausea, vomiting, bloating, abdominal pain, and weight loss were the most common symptoms. Two thirds of these patients had a well-documented history of peptic ulcer before their initial operations; in other, surgery was performed for other reasons, such as obesity (5%) or reflux esophagitis (8%). Twelve patients had undergone truncal vagotomy and a “drainage operation” and 48 had received a partial gastrectomy with a gastroenterostomy: Billroth I (n = 8), Billroth II (n = 11), Roux-en-Y (n = 29). All patients had recordings of gastrointestinal manometry; 16 also had a scintigraphic measurement of gastric empyting. Measurements were compared with data from healthy controls. Gastric manometry, which could be assessed only in the group with an intact antrum, was characterized by antral hypomotility (p < 0.05). Gastric emptying studies showed rapid early emptying of liquids and delayed emptying of solids (both p < 0.05). In the whole group, fasting jejunal motility was characterized by absence of phase II in 13, presence of bursts of phasic activity in 18, and abnormal propagation of phase III in 8. A significantly increased frequency of phase III of MMC was noted in the patients after Billroth II and Roux-en-Y operations. Postprandially, 19 patients failed to develop a “fed pattern.” In 11 of 35 patients, the fed pattern was of shorter duration than in healthy controls; in others, there were postprandial MMC-like complexes that did not interrupt the fed pattern. Motor disturbances, which occur frequently in patients symptomatic after gastric surgery, are associated with the development of gastric stasis. These physiologic abnormalities may represent a persistence or aggravation of a preoperative psychophysiologic status, or they may be a bonafide motility disorder, such as antral hypomotility. Some of these abnormalities may have been present preoperatively and may have been the cause of the upper gut symptoms before operation, particularly in those without documented peptic ulcer disease. The lack of enteric continuity following Billroth II and Roux-en-Y gastrectomy may predispose to the manometric abnormalities we observed. We discuss the therapeutic implications of these pathophysiological findings.

Original languageEnglish (US)
Pages (from-to)505-512
Number of pages8
JournalJournal of clinical gastroenterology
Volume12
Issue number5
DOIs
StatePublished - Oct 1990

Keywords

  • Billroth I and II
  • Gastric emptying
  • Gastric stasis
  • Gastric surgery
  • Motility
  • Roux-en-Y gastrectomy
  • Vagotomy

ASJC Scopus subject areas

  • Gastroenterology

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