Gastric emptying of solid meals after truncal vagotomy and pyloroplasty in human subjects

Cowley, David J.; Vernon, Peter; Jones, Thomas F.; Glass, H. I.; Cox, Alan G.

doi:10.1136/gut.13.3.176

Cited by 78 publications

(29 citation statements)

References 9 publications

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“…Pumping action of the antrum is weakened after vagal denervation (Cowley et al 1971;Medina 1982), and animals subjected to a total vagotomy show gastric distension and retention (Kraly et al 1986). In the present study, a greater amount of gastric content and greater gastric distension were observed in the vagotomized exercise group than in the vagotomized sedentary group after 24-h fasting.…”

Section: Fig 3 Antral and Duodenal Motilities In The Vagotomized Ramentioning

confidence: 99%

Vagal Nerve Regulation Is Essential for the Increase in Gastric Motility in Response to Mild Exercise

Wang

Kondo

Suzukamo

et al. 2010

Tohoku J. Exp. Med.

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It has been shown that mild to moderate exercise can accelerate gastric emptying in humans. However, understanding of the underlying mechanism is hampered by the lack of appropriate animal models. To investigate the effects of mild exercise on gastric motility, we developed an animal model, in which strain gauge transducers were surgically planted on the antral surfaces of female Sprague-Dawley rats. We continuously recorded the contractions of gastric circular muscle in unrestrained conscious rats, divided into four groups: sham-operated exercise, sham-operated sedentary, vagotomized exercise, and vagotomized sedentary. The rats were trained for 3 weeks, and gastric motility was monitored before and after exercise. Although exercise accelerates gastric antral contraction in sham-operated rats, this effect was absent in the vagotomized exercise group, indicating the involvement of the vagal nerve in the exercise-mediated increase in gastric motility. Among the four groups, daily food intake was highest in the sham-operated exercise group. In contrast, the vagotomized exercise group exhibited the smallest body weight gain. Severe gastric retention was observed in vagotomized rats, suggesting a role of the vagal nerve in facilitating food movement and digestion in the stomach. Moreover, at the end of the 3-week exercise, there were no differences in plasma levels of growth hormone, peptid YY, and ghrelin among the four groups. These results indicate that in response to a mild physical exercise challenge, the vagal nerve stimulates gastric motility and enhances the ability of the stomach to process food. Our findings highlight the significance of neuronal control of stomach function.

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Section: Fig 3 Antral and Duodenal Motilities In The Vagotomized Ramentioning

confidence: 99%

Vagal Nerve Regulation Is Essential for the Increase in Gastric Motility in Response to Mild Exercise

Wang

Kondo

Suzukamo

et al. 2010

Tohoku J. Exp. Med.

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“…However, the rate at which emptying returns to normal may be related to gastric outlet size, as the emptying times of the patients with a large outlet had returned to normal limits 4-6 months postoperatively, whereas that of those with a relatively small outlet was still delayed. However, previous studies (Cowley et al, 1972) have shown that the gastric emptying of patients with smaller gastric outlets also returns to normal more than 1 year after operation.…”

Section: Discussionmentioning

confidence: 89%

“…Cowley et al (1972) found that gastric emptying of solid meals was slower than that of a normal control group, both at 1 4 weeks and later at 1 4 months after vagotomy and pyloroplasty. However, emptying had returned to normal in patients tested more than 1 year after operation.…”

mentioning

confidence: 84%

The effect of the size of the gastric outlet on gastric emptying after vagotomy for duodenal ulcer

George

Cowley

Royston

et al. 1975

Journal of British Surgery

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Gastric emptying of isotopically labelled solid meals was studied in normal human subjects and in 30 patients who had had an operation for chronic duodenal ulcer. Each patient had a vagotomy of the whole stomach combined with either a Finney pyloroplasty to produce a large gastric outlet or a Heineke-Mikulicz pyloroplasty to produce a relatively small outlet. At 10-22 days after operation gastric emptying was equally and significantly slowed in both groups when compared with the normal controls. This delay occurred regardless of whether the vagotomy was complete or incomplete. At 4-6 months after operation emptying had returned to normal in the patients who had had a Finney pyloroplasty but remained significantly slowed after Heineke-Mikulicz pyloroplasty. Mild symptoms of gastric stasis frequently occurred in both groups in the early postoperative period, but were rare 4-6 months after operation. There was no correlation between the incidence of these early symptoms of stasis and the size of the gastric outlet constructed.

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“…On peut s'attendre ~t un retour ~t la normale dans les trois ans. 13 Le reflux gastro-oesophagien est associ6 ~ une rttention significative de la nourriture solide dans 57% des patients alors que les autres ont une vidange normale ou acctltrte. Le reflux gastro-oesophagien et Pulc~re gastrique ne retardent pas la vidange des liquides.…”

Section: La Physiologic Gastriqueunclassified

New guidelines for preoperative fasting

Maltby

1993

Can J Anaesth

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The basic physiology of digestion and gastric emptying has been known since before the discovery of general anaesthesia. In 1833, Beaumont I published direct observations of a patient who suffered a gunshot wound which healed leaving a gastric fistula. He observed that solid foods, such as meat and potatoes, which were stored in the stomach and took 3-6 hr to be converted into semifluid chyme and to pass completely from the stomach. He also recorded that clear fluids are "not affected by gastric juice and are emptied almost as soon as they enter the stomach." Modem dual isotope studies, 2 in which solids and liquids are tagged with different radioactive isotopes, confirm Beaumont's findings that solids require several hours for emptying while clear liquids take less than two hours.The stomach is a very distensible storage organ which can accommodate more than one L during eating and drinking before there is any increase in intragastric pressure. 3 Gastric secretions mix with food to break it down into small particles to form semi-fluid chyme which empties slowly through the pylorus into the small intestine. Most of the peristaltic contractions in the antrum are weak and mix the food and gastric secretions. Strong contractions occur about 20% of the time and their intensity determines the rate of stomach emptying. Increased volume in the stomach promotes emptying, not by increasing intragastric pressure, but by stretching of the stomach wall which elicits reflexes that increase the activity of the pyloric pump, while slightly inhibiting the tone of the pyloric sphincter. Certain foods, particularly meat, cause the release of gastrin from the antral mucosa; this stimulates secretion of highly acid gastric juice from the fundus and also stimulates the pyloric pump to promote gastric emptying.The presence of excess ehyme in the duodenum evokes nervous reflexes in the duodenal wall that inhibit gastric emptying. Factors that excite these enterogastric reflexes include distention of the duodenum, acidity and osmolality of the chyme, and the presence of certain breakdown products, especially from proteins and fats. 3 The upper intestine also releases hormones, mainly in response to fats, that delay gastric emptying by inhibiting the pyloric pump and increasing the tone of the pyloric sphincter.Indigestible solids that cannot be broken down to <2 mm diameter are emptied by a different mechanism during the fasting state. A distinct four-phase cycle, the interdigestive myoelectric complex, 4 recurs approximately every two hours. During the second hour of the cycle the pylorus remains open and larger particles are emPtied. This cycle explains why solids such as peas and carrots (with a high cellulose content which is broken down very slowly) often remain in the stomach for many hours after easily digestible solids have emptied.Emptying of liquids depends on the pressure gradient between the stomach and the duodenum, the intragastric pressure being generated by slow, sustained gastric contractions in the proximal portion of...

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Gastric emptying of solid meals after truncal vagotomy and pyloroplasty in human subjects

Cited by 78 publications

References 9 publications

Vagal Nerve Regulation Is Essential for the Increase in Gastric Motility in Response to Mild Exercise

Vagal Nerve Regulation Is Essential for the Increase in Gastric Motility in Response to Mild Exercise

The effect of the size of the gastric outlet on gastric emptying after vagotomy for duodenal ulcer

New guidelines for preoperative fasting

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