Enhancement of Gastric Emptying of Solids by Erythromycin in Patients With Roux-en-Y Gastrojejunostomy

Abstract

Background: Roux-en-Y reconstruction is sometimes associated with symptoms that suggest food stasis, as a result of dysmotility of either the gastric remnant and/or the efferent jejunal limb. Objective: To study the possible effect of intravenous erythromycin lactobionate on gastric emptying of solids in patients who have undergone a Roux-en-Y procedure. Patients: Twenty-four patients with a Roux-en-Y procedure participated in the study. Ten of them had undergone truncal vagotomy with pyloroplasty; the remaining 14 had undergone a Billroth II subtotal gastrectomy as the initial antiulcer procedure. Sixteen healthy subjects served as controls. Methods: All healthy subjects and patients underwent assessment of gastric emptying of a standard radiolabeled solid meal after administration of placebo or 200 mg of erythromycin lactobionate intravenously. Scanning was done with a gamma camera, and emptying curves were constructed. From these curves the half-time of gastric emptying was calculated. Results: Patients with severe symptoms of gastric stasis had a significantly longer half-time than did patients with mild or no symptoms (P = .002). Patients with a Billroth II subtotal gastrectomy as the initial antiulcer procedure had a significantly worse grade of symptoms (P = .01) and a significantly prolonged half-time (P = .02) compared with patients with a truncal vagotomy with pyloroplasty as the initial antiulcer procedure. Erythromycin significantly reduced the half-time in the controls (PϽ.001) and all patients after Roux-en-Y procedure (PϽ.001). Conclusion: Erythromycin could be a useful prokinetic drug in patients with Roux stasis syndrome.

Post-surgical and obstructive gastroparesis

“…The effects of standard drugs have not been well studied recently, but the older literature suggests limited efficacy with metoclopramide; cisapride may have been more effective but is no longer on the market [30]. A study on the use of intravenous erythromycin in 24 patients with Roux-en-Y stasis syndrome showed impressive improvements (by nearly threefold) in gastric emptying in all patients, regardless of the underlying surgery; unfortunately, the authors provided no information on changes in symptoms [31]. A more recent case report suggests that tegaserod may have some value in this setting; however, this drug is no longer generally available [32].…”

Induced-Hyperglycemia Attenuates Erythromycin-Induced Acceleration of Hypertonic Liquid-Phase Gastric Emptying in Type-I Diabetic Patients

“…Suppression of the cholinergic transmission could insustained antral peristaltic contraction [18][19][20][21] and by overcoming the inhibitory effect of excited duodenal hibit antral motility, and probably justifies the mechanism by which hyperglycemia reduces gastric emptying after osmo-or glucoreceptors on gastric emptying. Erythromycin enhances the gastric emptying of inert fluids [23] and, administering erythromycin in humans.…”

Laparoscopic Modified Taylor Procedure in the Treatment of Duodenal Ulcer: Technique and Outcome after 5-Year Follow-Up

“…This may partly be explained by the abolition of vagally mediated adaptive relaxation that causes, for a given volume, an increase of intragastric pressure, responsible for an increase of gastric emptying of liquids [39,41]. However, these symptoms are a temporary and are inversely related to the time that passed since the operation [24,25]. A mean 5-year period thereafter, complete recovery of gastric emptying was observed.…”

“…A mean 5-year period thereafter, complete recovery of gastric emptying was observed. These changes may also be explained by the function that can be taken over by the intrinsic nerve plexus [25] and maybe by the anterior branches. Liquid emptying investigations were similar to those obtained with the healthy controls (table 1) and were rather better than those of patients after HSV [33], so this mechanism appears to have no major clinical effect.…”