The effect of erythromycin on bile excretion and proximal small bowel motility following divided gastric bypass surgery: a prospective randomized placebo-controlled trial.
BACKGROUND
No conclusive data exists supporting the use of any prokinetic agent in the postoperative setting. The study was designed to examine the effect of erythromycin on small bowel motility in a placebo-controlled trial of post gastric bypass patients utilizing a standardized nuclear medicine test.


METHODS
A consecutive series of 21 patients undergoing elective gastric bypass surgery for morbid obesity between September 1999 and March 2001 were enrolled in this prospective double-blind randomized controlled trial. Standard open, divided gastric bypass was performed. Patients were randomized to receive either erythromycin 250 mg i. v. (11 patients) or placebo (10 patients) every 8 hours. On postoperative day 2, a hepatic iminodiacetic acid (HIDA) scan was obtained. Tracer movement through the biliary tree and proximal small bowel was quantified and compared.


RESULTS
Tracer clearance from the liver and biliary tree was no different between groups from time of injection through 1 hour. Tracer material clearance from the duodenum into the jejunum was no different between the erythromycin and control groups at 1 hour, 37% +/- 13% and 37% +/- 22% respectively (P = 0.95). At 4 hours, clearance was greater in the erythromycin group, 77% +/- 6%, compared to control, 60% +/- 20% (P = 0.036). The rate of tracer change between hour 1 and 4 (slope) was steeper in the erythromycin group (P = 0.048).


CONCLUSIONS
Erythromycin increases intestinal transit in the postoperative setting.
Wilkinson
Neal W
NW
Department of Surgery, Eisenhower Army Medical Center, Fort Gordon, GA, USA. Neal.Wilkinson@RoswellPark.org
Gustafson
Robert J
RJ
Frizzi
James D
JD
D001646:Bile / Q000378:metabolism*; D001659:Biliary Tract / Q000000981:diagnostic imaging; D004311:Double-Blind Method; D004386:Duodenum / Q000000981:diagnostic imaging; D004917:Erythromycin / Q000494:pharmacology*; D015390:Gastric Bypass; D005765:Gastrointestinal Agents / Q000494:pharmacology*; D005769:Gastrointestinal Motility / Q000187:drug effects*; D005772:Gastrointestinal Transit / Q000187:drug effects; D006801:Humans; D007098:Imino Acids; D008099:Liver / Q000000981:diagnostic imaging; D009767:Obesity, Morbid / Q000503:physiopathology / Q000601:surgery; D011184:Postoperative Period; D011446:Prospective Studies; D011877:Radionuclide Imaging
D005765:Gastrointestinal Agents; D007098:Imino Acids; D004917:Erythromycin; C049470:lidofenin