Intestinal function after total gastrectomy and possible consequences of gastric replacement

Abstract

About half of the patients subjected to total gastrectomy experience weight loss. Malabsorption, particularly fat malabsorption, is a common feature after total gastrectomy. This may be due to shortened intestinal transit time and small bowel bacterial overgrowth, but is less often due to diarrhea or pancreatic exocrine insufficiency. Malabsorption is not closely related to weight loss, which is mainly caused by recurrent malignant diseases and a low postoperative calorie intake. The low calorie intake persists in half of the patients despite supervision of the patients by clinical nutritionists at the outpatient clinic. Roux-en-Y reconstruction of the esophago-intestinal canal has minimized the problem of postoperative reflux esophagitis. Severe postprandial symptoms are uncommon although epigastric oppression and fullness is an obligatory feature in the immediate postoperative period but successively vanishes in half of the patients.Gastric replacement by various enteric reservoirs has been used to improve nutrition after total gastrectomy. The effect of gastric replacement is, however, uncertain since no prospective, randomized studies are available. A gastric substitute seems to have only a marginal effect on meal size, daily caloric intake, and weight gain. A reservoir function of gastric substitutes has been documented but the effect on intestinal transit time is unknown. Stagnation of intestinal contents in a gastric replacement is common, but its significance for bacterial overgrowth, malabsorption, and clinical outcome remains to be determined.

Treatment of Devastating Postgastrectomy Symptoms: The Potential Role of Jejunal Pouch Reconstruction

“…Pancreatico-cibal asynchrony, leading to increased fat loss and impaired weight gain, may add to the problem after Billroth II or other duodenal bypassing operations [9]. One of the most significant and prevalent pathophysiological conditions which may result in malabsorption is bacterial overgrowth in the small intestine [10]. The incidence of significant bacterial overgrowth in patients following Billroth II operations has been estimated to be 30–50%.…”

“…The most common secondary manifestations are vitamin B 12 malabsorption and fat malabsorption, which may result in deficiencies of the fat-soluble vitamins. Normal motility and gastric acid output are the primary factors suggested for determining normal levels of small intestinal bacteria [10]. …”

Optimal gastric pouch reconstruction post-gastrectomy

“…toms characterized by symptoms of early satiety, epigastric discomfort, nausea, and vomiting [1]. Reduction in calorie intake due to loss of stomach volume appears to be the single most important determinant of weight loss post-gastrectomy [2,3].…”

Total Gastrectomy for Gastric Cancer: 12-Year Data and Review of the Effect of Performing Lymphadenectomy.

“…Borchard (1990) reported that the autopsy confirmation of the frequency and localization of the metastatic spread of gastric cancer was to the liver in 34.3% -54.3% and to the peritoneum in 17.0% -28.4% in the world literature. Moreover, about half of all patients subjected to total gastrectomy experience weight loss, malabsorption (particularly of fat absorption), after TG (Olbe and Lundell, 1987).…”