Plasma 25-hydroxyvitamin D and urinary cyclic AMP in German patients with subtotal gastrectomy (Billroth II)

Abstract

In an attempt to clarify the pathogenesis of the disturbed calcium metabolism which sometimes follows partial gastrectomy, we determined plasma 25-hydroxyvitamin D (25-OH-D) concentrations and urinary cyclic 3',5'-adenosine monophosphate (cAMP) excretion in patients who had previously undergone Billroth II gastrectomy and who were without clinical evidence of bone disease. In 17 Billroth II patients plasma 25-OH-D concentrations were reduced (12.6 +/- 4.6 ng/ml, mean +/- SD) compared to values in 17 control patients with diseases not affecting calcium metabolism (31.6 +/- 12.9 ng/ml, P less than 0.001). Urinary cAMP excretion, in part reflecting parathyroid function, was higher in 17 Billroth II patients (5.0 +/- 2.5 micronmol/day) than in the control patients (2.6 +/- 1.3 micronmol/day, P less than 0.001). These results suggest impaired nutrition of vitamin D and secondary hyperparathyroidism in Billroth II patients. While the cause of this phenomenon is unclear, it may contribute to the disturbance of calcium metabolism in patients who have had subtotal gastrectomy.

Preserving Duodenal Passage for Bone Mineralization: Billroth I versus Billroth II Reconstruction After Partial Gastrectomy in Growing Minipigs

“…The impaired calcium absorption in BII animals compared with BI animals correlates with an increase in 1,25 (OH)2 D3 toward to the end of the study, since 1,25 (OH)2D3 stimulates the transport of calcium from the small intestinal lumen into the circulation [31]. Normal values in serum Ca were observed in our series 10 mo after operation and later, which was also reported in humans after gastrectomy in a period of 1 to 10 y postoperatively [12,13,15,19,32]. However, a significant decrease in serum calcium has rarely been reported in gastrectomized patients, although serum calcium remains in the normal range [33,34].…”

“…In BII animals, serum levels were significantly reduced compared with those in BI animals by the end of the study. In gastrectomized patients, most studies report a decrease in serum 25(OH)D3 [15,[33][34][35][36]. Impaired absorption, insufficient intake, or both have been suggested as the cause of low 25(OH)D after gastrectomy [16,37,38].…”

“…Decreased absorption of calcium or vitamin D as well as insufficient oral intake of calcium or vitamin D have been suggested as possible causes of postgastrectomy bone disease [11][12][13][14][15][16].…”

Osteoporosis in Gastrointestinal, Pancreatic, and Hepatic Diseases

“…Urinary calcium excretion tends to be low and phosphate clearance increased [61]. PTH values may be elevated [72] but are normal in most patients [59,[73][74][75], although urinary cAMP levels may be increased [76], suggesting mild hyperparathyroidism. 25OHD levels tend to be reduced in most studies [59,[73][74][75].…”

Calcium- und Knochenstoffwechsel nach Gastrektomie

“…Der Abfall des Serumcalciums muß vom Organismus umgehend gegenreguliert werden, da die Regulation des Serumcalciums in engen Grenzen fü r die Homö ostase unabdingbar ist [11]. Jeder Abfall des Serumcalciums wird unmittelbar von einer Parathormonausschü ttung beantwortet [26], entsprechend konnte ein Anstieg des Parathormons nach Gastrektomie beobachtet werden [32,34,35,60,68]. Calciumregulation und Knochenstoffwechsel sind ü ber das Parathormon und die Metabolite des Vitamin D eng miteinander verknü pft [26,47].…”