Enhancement of gastric emptying of solids by erythromycin in patients with Roux-en-Y gastrojejunostomy.
BACKGROUND
Roux-en-Y reconstruction is sometimes associated with symptoms that suggest food stasis, as a result of dysmotility of either the gastric remnant and/or the efferent jejunal limb.


OBJECTIVE
To study the possible effect of intravenous erythromycin lactobionate on gastric emptying of solids in patients who have undergone a Roux-en-Y procedure.


METHODS
Twenty-four patients with a Roux-en-Y procedure participated in the study. Ten of them had undergone truncal vagotomy with pyloroplasty; the remaining 14 had undergone a Billroth II subtotal gastrectomy as the initial antiulcer procedure. Sixteen healthy subjects served as controls.


METHODS
All healthy subjects and patients underwent assessment of gastric emptying of a standard radiolabeled solid meal after administration of placebo or 200 mg of erythromycin lactobionate intravenously. Scanning was done with a gamma camera, and emptying curves were constructed. From these curves the half-time of gastric emptying was calculated.


RESULTS
Patients with severe symptoms of gastric stasis had a significantly longer half-time than did patients with mild or no symptoms (P=.002). Patients with a Billroth II subtotal gastrectomy as the initial antiulcer procedure had a significantly worse grade of symptoms (P=.01) and a significantly prolonged half-time (P=.02) compared with patients with a truncal vagotomy with pyloroplasty as the initial antiulcer procedure. Erythromycin significantly reduced the half-time in the controls (P<.001) and all patients after Roux-en-Y procedure (P<.001).


CONCLUSIONS
Erythromycin could be a useful prokinetic drug in patients with Roux stasis syndrome.
Department of General Surgery, University Hospital of Heraklion, Medical School, University of Crete, Greece.
J
J
Petrakis
J S
JS
Vassilakis
N
N
Karkavitsas
G
G
Tzovaras
E
E
Epanomeritakis
J
J
Tsiaoussis
E
E
Xynos
D000328:Adult; D000368:Aged; D000713:Anastomosis, Roux-en-Y; D004917:Erythromycin / Q000031:analogs & derivatives* / Q000627:therapeutic use; D005260:Female; D005502:Food; D005746:Gastric Emptying / Q000187:drug effects* / Q000502:physiology; D005774:Gastrostomy / Q000009:adverse effects / Q000379:methods; D006801:Humans; D007582:Jejunostomy / Q000009:adverse effects / Q000379:methods; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000503:physiopathology / Q000517:prevention & control*
C010948:erythromycin lactobionate; D004917:Erythromycin