Oral erythromycin improves gastrointestinal motility and transit after subtotal but not total gastrectomy for cancer.
BACKGROUND
Erythromycin has been shown to be a powerful prokinetic of the gastrointestinal tract. Little is known about its value to improve motility and transit in gastrectomized patients.


METHODS
Thirteen disease-free patients subjected to subtotal gastrectomy and 11 subjected to total gastrectomy for gastric cancer entered the study. Gastrointestinal transit of a standard 99mTc-labelled meal and fasting motility were studied before and after oral erythromycin.


RESULTS
In patients who had subtotal gastrectomy mean(s.d.) gastric half-emptying time was 42(14) min before and 26(11) min after erythromycin (P = 0.011). Before erythromycin prolonged rhythmical contractions (3 per min) were recorded in eight patients, sporadic non-organized contractions in two and prolonged bursts of waves in one. After erythromycin, clustered waves resembling a migrating motor complex (MMC) appeared in eight patients, while rhythmic motor activity was unchanged in three. In patients who had total gastrectomy jejunal half-emptying time was 39(18) min before and 45(12) min after erythromycin. In eight patients, frequent MMCs were recorded, peristaltic in four, synchronous in one, antiperistaltic in two, with clusters of non-propagated waves in one. After erythromycin, longer peristaltic MMCs were recorded in three, antiperistaltic MMCs persisted in two, synchronous in one and clusters of non-propagated waves in two.


CONCLUSIONS
Oral erythromycin improves gastrointestinal transit and motility after subtotal gastrectomy. The findings after total gastrectomy are controversial.
Altomare
D F
DF
Istituto di Clinica Chirurgica, Università degli Studi di Bari, Italy.
Rubini
D
D
Pilot
M A
MA
Farese
S
S
Rubini
G
G
Rinaldi
M
M
Memeo
V
V
D'Addabbo
A
A
D000284:Administration, Oral; D000328:Adult; D000368:Aged; D004917:Erythromycin / Q000008:administration & dosage* / Q000494:pharmacology; D005260:Female; D005743:Gastrectomy / Q000379:methods*; D005765:Gastrointestinal Agents / Q000008:administration & dosage* / Q000494:pharmacology; D005769:Gastrointestinal Motility / Q000187:drug effects*; D005772:Gastrointestinal Transit / Q000187:drug effects; D006801:Humans; D008297:Male; D008365:Manometry; D008875:Middle Aged; D011184:Postoperative Period; D013274:Stomach Neoplasms / Q000503:physiopathology / Q000601:surgery*
D005765:Gastrointestinal Agents; D004917:Erythromycin