Patients after Roux-en-Y gastrojejunostomy frequently complain of upper abdominal pain, fullness, nausea and vomiting. This study was performed to clarify the relationship of this Roux-en-Y syndrome to transit disorders in the gastric remnant and Roux limb, and to vagal status. Using a questionnaire, 35 of 66 patients operated on between 1976 and 1987 were judged to suffer from the Roux syndrome. Gastrojejunal transit was studied by scintigraphy with a solid test meal in 61 patients, 34 of whom were symptomatic. The median (interquartile range) gastric half-emptying time was longer in symptomatic than in asymptomatic patients (79 (43-146) versus 56 (27-79) min, P < 0.05), and in patients with a bilateral vagotomy than in those without a vagotomy (94 (43-225) versus 59 (31-77) min, P < 0.05). Stasis in the Roux limb was observed in 18 of 28 symptomatic and in only three of 27 asymptomatic patients (P < 0.01). The median (interquartile range) fraction of activity emptied from the stomach and remaining in the Roux limb at 60 min was 54 (39-60) per cent in symptomatic patients and 33 (21-40) per cent in those without symptoms (P < 0.01). Stasis in the Roux limb was not related to vagal status. No relationship between slow gastric emptying and Roux-limb stasis was found. Slow gastric emptying, Roux-limb stasis or a combination of both was found in 30 of 34 symptomatic and in only nine of 27 asymptomatic patients (P < 0.01). It is concluded that both slow gastric emptying and Roux-limb stasis can be interpreted as causing the Roux syndrome. Vagotomy seems to be the major cause of slow gastric emptying, but it is not related to stasis in the Roux limb.

After a Roux-en-Y gastrojejunostomy patients frequently complain about abdominal pain, fullness, nausea and vomiting, ie, the Roux-en-Y syndrome. Stasis in the Roux limb due to disordered motility is known to be a cause of these complaints. The aim of the present study was to determine whether vagal denervation contributes to the development of motility disturbances and stasis in the Roux limb. Forty-seven patients with a Roux-en-Y gastrojejunostomy after partial gastrectomy were studied. A truncal vagotomy had been performed in 26 of these 47 patients. Transit through the Roux limb was evaluated by radionuclide studies, motility in the Roux limb was studied by manometry, and vagal function was tested by measuring the pancreatic polypeptide response to an insulin-induced hypoglycemia (PP test). On the basis of the PP test patients were classified as having (1) normal, (2) moderately impaired, and (3) severely impaired vagal function. The PP test showed that two of the 26 patients subjected to vagotomy had a moderately impaired vagal function, the other 24 all had a severely impaired vagal function. In the patients not subjected to a vagotomy, vagal function was disturbed in 11 of the 21 patients. Motility disturbances were not observed more frequently in patients with either moderately or severely impaired vagal function than in patients with normal vagal function. Stasis in the Roux limb was seen even more frequently in patients with a normal vagal function than in patients with a severely impaired vagal function.(ABSTRACT TRUNCATED AT 250 WORDS)

with cisapride long-lasting symptomatic relief and improved transit is achieved in about 40% of patients with the Roux-en-Y syndrome.

Van der Mijle HCJ. Kleibeuker JH, Bleichrodt RP, Limburg AJ, Hesselink EJ. Gastric and jejunal motility disturbances after Roux-en-Y gastrojejunostomy. Scand J Gastroenterol 1989, 24(suppl 171), 69-74Roux-en-Y gastrojejunostomy is effective in preventing alkaline reflux into the gastric remnant. A substantial number of patients with a Roux-en-Y diversion complain about abdominal pain, epigastric fullness, nausea, and vomiting, worsened by eating. Clinical and experimental studies have shown that gastroparesis of the gastric remnant and motility disturbances of the Roux limb probably both have a role in the pathogenesis of this so-called Roux-en-Y syndrome. Vagal denervation due to truncal vagotomy is thought to worsen the abnormal motoric function. In a study in 21 patients we observed slow gastric emptying in symptomatic patients without vagal function. Slight manometric abnormalities and stasis of food in the Roux limb were observed in several patients, without, however, a clear correlation with symptoms. Except for near total gastrectomy in selected patients effective treatment is not yet available for these patients, several of whom are severely disabled by their symptoms.