The effects of vagotomy on the intestinal handling of water and electrolytes

Abstract

SUMMARY A technique of intestinal perfusion has been used to investigate the effects of vagotomy on the intestinal handling of water and electrolytes. The capacity of the vagotomized jejunum to absorb water and electrolytes was found to be unimpaired, even in patients who had severe postvagotomy diarrhoea.Diarrhoea is well recognized as a cause of morbidity after the operation of vagotomy and gastric drainage for duodenal ulceration. Diarrhoea may be said to represent the malabsorption ofwater and electrolytes, and in spite of a great deal of investigation the cause ofthis diarrhoea remains unexplained. The possibility that a defect in the ability of the intestine to absorb water and electrolytes may explain this diarrhoea has been investigated, and in this paper we report on the intestinal handling of water and the principal electrolytes-sodium and potassium-immediately after operation when the effects of vagotomy might be expected to be maximal and later, in patients with and without severe postvagotomy diarrhoea. Patients StudiedSuccessful studies were performed upon 25 subjects; nine of these were patients undergoing truncal vagotomy and nine were patients undergoing cholecystectomy. Of these 18 patients, all except one of them were studied twice immediately after operation, first at six hours and again between 24 and 30 hours after operation.Of the nine patients undergoing vagotomy, three were studied on the day before operation and four of the patients undergoing cholecystectomy were also studied on the day before operation. Additional control data were obtained from four healthy volunteer subjects not undergoing surgery; one of these was studied on two occasions, giving a total of 12 control, or contrast studies. These contrast studies are assumed to represent normal absorption before operation.'Please address requests for reprints to Mr G. A. Bunch, The Royal Infirmary, Ifuddersfield.Received for publication 6 December 1972. After the 10th postoperative day, three patients who had had a vagotomy were studied and three patients with severe postvagotomy diarrhoea who passed frequent, watery stools daily were also studied. Technique of StudyPatients were studied using a technique of intestinal perfusion similar to that described by Phillips and Summerskill (1966). The principle of the method is that a segment of small intestine is perfused with a test solution of known composition. At the end of the test segment the perfusate is sampled by aspiration and analysed. From the change occurring in the volume and composition of the test solution during its passage through the test segment, the rate of absorption from the segment can be calculated.A double-lumen tube, suitably modified (Fig.), was passed through the nose until it reached the upper jejunum. The position of the tube was ascertained by radiographic screening. The proximal balloon (C in the figure) was sited just beyond the duodeno-jejunal flexure.The test solution was modified Tyrode's solution containing Na+-149 m-equiv/1, K+-3.3 m-equiv/1, Cl--1...

Lack of evidence in vivo for a remote effect of Escherichia coli heat stable enterotoxin on jejunal fluid absorption

“…The present fluid recovery method measures only loss from the lumen without the confounding effect of changes in interstitial weight or volume, as measured by other gravimetric methods. 6 It has been a consistent finding that vagotomy alone has little or no effect on fluid absorption, [14][15][16][17] although it alters mesenteric blood flow 9 and increases intestinal peripheral resistance. 16 Cervical vagotomy increases heart rate, blood pressure and intestinal peripheral resistance, 18 even though there are thought to be no vagal vasodilator fibres.…”

“…It has been a consistent finding that vagotomy alone has little or no effect on fluid absorption, 14–17 although it alters mesenteric blood flow 9 and increases intestinal peripheral resistance 16 . Cervical vagotomy increases heart rate, blood pressure and intestinal peripheral resistance, 18 even though there are thought to be no vagal vasodilator fibres.…”

Cephalic Reflexes: Their Role in Digestion and Possible Roles in Absorption and Metabolism

“…The vagus has been shown to mediate many of the cephalic phase responses as described previously and may be involved in mediating cephalic-induced changes in intestinal function. How ever, although the vagus has a demonstrable effect on the motor and secretory functions of the gastrointes tinal tract, direct control of intestinal absorption has been difficult to demonstrate (50,(59)(60)(61). On the other hand, sympathetic stimulation appears to increase the absorption of fluid and electrolytes (50,62,63).…”

Effect of Vagal Nerve Stimulation on <i>L</i>-Leucine Absorption in the Cat Jejunum

“…Also Sjovall et al [6] failed to find evidence for effects on fluid absorption following vagal nerve stimulation in cat. Sim ilar conclusions were reached after the obser vation that water and electrolyte absorption were unimpaired following vagotomies in man [7], However, several studies have re ported an increase in absorption following administration of atropine [3,8]. No previous attempt has been made to observe directly the process of absorption of amino acids across the small intestine following vagal stimula tion.…”