Effect of various prokinetic agents on post Roux-en-Y gastric emptying. Experimental and clinical observations.
The effect of various prokinetic drugs was assessed in animals with Roux-en-Y gastrojejunostomy. The agents tested were (1) bethanechol 2.5 mg subcutaneously at 0 min and 30 min postprandially (pp); (2) metoclopramide 20 mg intravenous bolus at 0 min pp; (3) a combination of 1 and 2; (4) oxytocin 5 mg intramuscularly at 0 min and 240 min pp; (5) motilin at 100 ng/kg/hr; or (6) 300 ng/kg/hr continuous intravenous infusion from 0 to 270 min pp. Only bethanechol administration resulted in significantly less gastric retention (65 +/- 6% vs 32 +/- 5% retention at 5 hr). (P less than 0.002). The animal results with parenteral bethanechol were confirmed in humans with chronic delayed gastric emptying following Roux-en-Y gastrojejunostomy, with a decrease in gastric retention on radionuclide scan from 78.5 +/- 5% to 26 +/- 12% at 2 hr pp (P less than 0.01). Initially all patients responded with symptomatic improvement. However, subsequently 3/6 (50%) of patients required total or near total gastrectomy for recurrent symptoms of gastric stasis. Nevertheless, 2/6 (33%) of patients have no further evidence of gastric stasis, and a trial of bethanechol is recommended prior to considering further gastrectomy in patients with the Roux-stasis syndrome.
D000818:Animals; D018723:Bethanechol; D001626:Bethanechol Compounds / Q000494:pharmacology; D004285:Dogs; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D005743:Gastrectomy; D005746:Gastric Emptying / Q000187:drug effects*; D005763:Gastroenterostomy; D005765:Gastrointestinal Agents / Q000494:pharmacology*; D006801:Humans; D007583:Jejunum; D008787:Metoclopramide / Q000494:pharmacology; D009037:Motilin / Q000494:pharmacology; D010121:Oxytocin / Q000494:pharmacology
D001626:Bethanechol Compounds; D005765:Gastrointestinal Agents; D018723:Bethanechol; D010121:Oxytocin; D009037:Motilin; D008787:Metoclopramide