The effect of preserving antral innervation and of a pyloroplasty on gastric emptying after vagotomy in man

Clarke, Robert; Alexander-Williams, J

doi:10.1136/gut.14.4.300

Cited by 123 publications

(42 citation statements)

References 17 publications

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“…They explained their finding by a defect in receptive relaxation of the stomach due to visceral neuropathy secondary to malnutrition (Clarke and Alexander-Williams, 1973) as well as reduced ganglion plexuses in the intestine (Viteri and Schneider, 1974). These results are in disagreement with the present study, yet the studies showing reduced ganglion plexuses in the intestine did not discuss the intrinsic stomach innervations and thus should not be relied upon in explaining the delayed GET.…”

Section: Discussioncontrasting

confidence: 57%

Ultrasonographic gastric emptying in protein energy malnutrition: effect of type of meal and nutritional recovery

et al. 2004

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Objective and Design: The earlier reports of disturbed gastric motility in protein energy malnutrition (PEM) point out to its possible contribution in the difficulties faced during nutritional rehabilitation. This study was thus designed to assess the ultrasonographic gastric emptying time (GET) using 20 ml/kg body weight of both liquid and semisolid meals, in 27 patients suffering from PEM as well as in 15 healthy matching infants to delineate any defect present, its degree in different types of PEM and the effect of nutritional rehabilitation. Patients: The patients were recruited from the in-patient department of Children's Hospital, Ain Shams University, Cairo, Egypt. They were divided into three groups: 10 marasmic infants, 10 marasmic kwashiorkor (marasmic KWO) and seven kwashiorkor (KWO) cases. Ultrasonographic GET assessment was carried out within 72 h of admission and 3077 days after nutritional rehabilitation. Results: The gastric half-emptying time T(1/2) of both liquid and semisolid meals was markedly prolonged in patients with marasmus and marasmic KWO. It was more delayed for the semisolid than the liquid meals. This delay was reversible after nutritional rehabilitation of the patients, indicating that it was secondary to the malnourished status. On the other hand, T(1/2) of both liquid and semisolid meals showed no statistically significant delay in the KWO group and nutritional rehabilitation added no further to the results. Conclusion: PEM, especially marasmus and marasmic KWO, causes a delay in GET, which is reversible on nutritional recovery. This must be considered during nutritional rehabilitation of such patients to decrease the duration of their hospitalization and thus decrease the morbidity in PEM. Sponsorship: This study was supported by a university fund from

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Section: Discussioncontrasting

confidence: 57%

Ultrasonographic gastric emptying in protein energy malnutrition: effect of type of meal and nutritional recovery

et al. 2004

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“…The gastroduodenal junction (GDJ) plays an important role in regulating gastric emptying (Clarke & Williams, 1973;Aeberhard & Walther, 1978;Hinder & Bremner, 1978;Miller, Kauffman, Elashoff, Ohashi, Carter & Meyer, 1981;Hinder & SanGarde, 1983;Schulze-Delrieu & Brown, 1985). As the cineradiographs of Code and colleagues show (Smith, Code & Schlegel, 1957;Carlson, Code & Nelson, 1966) peristaltic contractions originating in the corpus spread aborally sweeping chyme towards the pylorus.…”

Section: Introductionmentioning

confidence: 99%

Organization of electrical activity in the canine pyloric canal.

Sanders

Vogalis

1989

The Journal of Physiology

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SUMMARY1. The electrical activity of the canine gastroduodenal junction was investigated using cross-sectional muscle preparations and intracellular recording techniques.2. Spontaneous electrical slow waves were recorded from antral and pyloric cells but not from duodenal cells adjacent to the pyloric region. Slow waves were generated in the antrum and propagated to the pyloric region via the circular layer. Pyloric slow waves consisted of an upstroke phase, a plateau phase and oscillations superimposed upon the plateau, whereas antral slow waves had smooth plateau potentials.3. Within the pylorus slow waves decayed in amplitude with distance from the myenteric border of the circular muscle; the majority of pyloric circular cells were normally electrically quiescent.4. The longitudinal muscle in the pylorus was electrically coupled and paced by the circular muscle. In longitudinal cells slow waves were usually of long duration with multiple spikes superimposed upon the plateau phase.5. Nifedipine (10-8 to 10-5 M) decreased slow wave amplitude and duration. Tetraethylammonium ions (TEA; 10 mm) increased the duration of slow waves, caused spiking activity during the plateau phase and also elicited spiking in the quiescent regions.6. The results suggest that gastric slow waves pace the myenteric portion of the circular muscle layer and the longitudinal layer of the pylorus, but do not traverse the gastroduodenal junction, nor pace the majority of cells within the circular muscle of the pylorus. Other excitatory mechanisms are necessary to activate these regions and to co-ordinate their motility with gastric motility.

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“…At the Gastric Follow-up Clinic, symptoms suggestive of gastric retention, such as vomiting and flatulence, have been less common after HSV than after TV or SV with a drainage procedure. Finally, studies of gastric emptying of fluids [9,32,62] and of food-and-barium [56,66,77] have revealed no evidence of gastric stasis in man after HSV, whereas complete gastric vagotomy without drain age frequently produces gastric stasis in man [10,50] and in experimental animals [2,70], Regulation o f gastric emptying. Although HSV does not produce gastric retention, the pattern of gastric emptying of fluids is altered.…”

Section: Gastric Emptying and Side Effects After Vagotomymentioning

confidence: 99%

“…HSV keeps intact both the terminal antrum, which mills and grinds solids and controls their emptying [8,11], and the pyloric sphinc ter, which helps to regulate gastric emptying and to prevent reflux of duode nal content into the stomach [9,19,34], In contrast, both the terminal antrum and the pylorus are sacrificed in the course of truncal or selective vagotomy with pyloroplasty. The average length of pre-pyloric stomach which remains innervated in HSV is about 6.5 cm [44], The anatomical landmarks provided by the nerves of Latarjet govern the extent of gastric denervation in HSV, whereas in the closely similar operation of parietal cell vagotomy (PCV) [1], the precise extent of the antrum is 'mapped' at the time of operation by means of a pH probe.…”

Section: Definitionsmentioning

confidence: 99%

Physiological and Clinical Significance of Highly Selective Vagotomy without a Drainage Procedure

Johnston¹

1974

Digestion

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This is an account of the first 5 ½-years’ experience of highly selective vagotomy (HSV), an operation which confines vagotomy to the parietal cell mass, leaving the gastric antrum innervated and the pyloric sphincter intact. Gastrin levels have been shown to be no higher after HSV than after truncal vagotomy (TV). The long-term reductions in acid output after HSV are approximately equal to the reductions which are found after TV or SV (selective vagotomy), but the response to insulin is greater after HSV than after TV or SV. Gastric emptying of fluids is under better control after HSV than after TV/SV with a drainage procedure (D). The gall bladder is dilated after TV, but not after SV or HSV. Pancreatic enzyme output in response to vagal stimulation is significantly greater after HSV than after TV + D. Faecal fat excretion is significantly less after HSV than after TV/SV+ D. Operative mortality after 400 HSVs was nil. Post-operative gastric stasis was very rare. Dumping and diarrhoea were significantly less common after HSV than after TV/SV + D: other side effects were no more common. Despite the presence of the innervated antrum, the incidence of recurrent ulceration after HSV was low. 88% of patients had excellent clinical results 2–4 years after HSV, compared with only 70% after vagotomy with drainage.

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The effect of preserving antral innervation and of a pyloroplasty on gastric emptying after vagotomy in man

Cited by 123 publications

References 17 publications

Ultrasonographic gastric emptying in protein energy malnutrition: effect of type of meal and nutritional recovery

Ultrasonographic gastric emptying in protein energy malnutrition: effect of type of meal and nutritional recovery

Organization of electrical activity in the canine pyloric canal.

Physiological and Clinical Significance of Highly Selective Vagotomy without a Drainage Procedure

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