Postgastrectomy polyneuropathy with thiamine deficiency.
OBJECTIVE
Polyneuropathy has been reported after gastrectomy performed to treat various lesions. Although thiamine deficiency is a possible cause of this neuropathy, the pathogenesis still remains to be clarified. Seventeen patients with peripheral neuropathy with thiamine deficiency after gastrectomy are described.


METHODS
Seventeen patients with polyneuropathy after gastrectomy accompanied by thiamine deficiency were selected. Patients were restricted to those with total or subtotal gastric resection to treat ulcer or neoplasm. Patients who had undergone operations to treat morbid obesity were excluded.


RESULTS
Intervals between the operation and onset of neuropathy varied from 2 months to 39 years. Most patients did not seem malnourished. Serum concentrations of B vitamins other than thiamine were nearly normal. Symmetric motor-sensory polyneuropathy, predominantly involving the lower limbs, had progressed over intervals varying from 3 days to 8 years. Relative degrees of motor and sensory impairment also varied extensively. Some cases that progressed rapidly mimicked Guillain-Barré syndrome. Electrophysiological and pathological findings were those of axonal neuropathy. Substantial functional recovery from polyneuropathy was seen in most patients by 3 to 6 months after initiating thiamine supplementation. Motor recovery was better than sensory recovery.


CONCLUSIONS
Various symptoms were seen in patients with postgastrectomy neuropathy. Thiamine deficiency should be considered in the differential diagnosis of motor-sensory polyneuropathy after gastrectomy.
Koike
H
H
Department of Neurology, Nagoya University School of Medicine, Nagoya 466-8550, Japan.
Misu
K
K
Hattori
N
N
Ito
S
S
Ichimura
M
M
Ito
H
H
Hirayama
M
M
Nagamatsu
M
M
Sasaki
I
I
Sobue
G
G
D000203:Activities of Daily Living; D000328:Adult; D000368:Aged; D001706:Biopsy; D003937:Diagnosis, Differential; D018450:Disease Progression; D005260:Female; D005743:Gastrectomy / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D009431:Neural Conduction; D011115:Polyneuropathies / Q000097:blood / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D020127:Recovery of Function; D013274:Stomach Neoplasms / Q000601:surgery; D013276:Stomach Ulcer / Q000601:surgery; D013831:Thiamine / Q000097:blood / Q000627:therapeutic use; D013832:Thiamine Deficiency / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology* / Q000503:physiopathology; D013997:Time Factors
D013831:Thiamine