Roux-limb motility after total gastrectomy and Roux-en-Y anastomosis in patients with Zollinger-Ellison syndrome.
The Roux-en-Y syndrome was defined as chronic nausea, intermittent vomiting, and chronic abdominal pain worsened by eating in patients who have undergone a gastrojejunostomy Roux-en-Y reconstruction for peptic ulcer. When these patients fasted, the Roux limb showed striking abnormalities in motor function; when postprandial, they failed to convert to normal fed-state motor activity. In contrast, patients with Zollinger-Ellison syndrome do well after similar surgery; they can eat most foods and maintain their body weight. We studied the motility of the Roux limb and jejunum in six patients with Zollinger-Ellison after an esophagojejunostomy Roux-en-Y anastomosis. Roux-limb motor activity in these patients, as characterized by the migrating motor complex, was more frequent, well organized, and in synchrony with the remaining jejunum; most subjects also converted to the fed state after a liquid meal. We suggest that the enteric nervous system is intact and functions normally in patients who have had a Roux-en-Y reconstruction for ulcer disease secondary to Zollinger-Ellison, but not in patients with idiopathic peptic ulcer disease.
Mathias
J R
JR
Department of Internal Medicine, University of Texas Medical Branch, Galveston 77550.
Khanna
R
R
Nealon
W H
WH
Browne
R M
RM
Reeves-Darby
V G
VG
Clench
M H
MH
D000328:Adult; D000713:Anastomosis, Roux-en-Y / Q000009:adverse effects; D004435:Eating / Q000502:physiology; D004946:Esophagostomy / Q000009:adverse effects; D005260:Female; D005743:Gastrectomy / Q000009:adverse effects*; D005769:Gastrointestinal Motility / Q000502:physiology*; D006801:Humans; D007583:Jejunum / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D016065:Myoelectric Complex, Migrating / Q000502:physiology; D010507:Periodicity; D011184:Postoperative Period; D015043:Zollinger-Ellison Syndrome / Q000503:physiopathology* / Q000601:surgery*