Delayed gastric emptying and intestinal hormones following pancreatoduodenectomy.
OBJECTIVE
Delayed gastric emptying (DGE) is frequently reported in patients following pancreatoduodenectomy (PD). The present study tested the hypothesis that gastrointestinal hormones known to effect gastric emptying contribute to DGE in patients after PD.


METHODS
Patients with (delayed, n = 9) or without clinical signs of DGE (non-delayed, n = 22) after PD were investigated. Plasma concentrations of motilin, glucagon-like peptide-1 (GLP-1), neurotensin, and peptide YY (PYY) and the gastric emptying rate (GER), assessed by the paracetamol absorption method were measured after a liquid meal on postoperative day 11.


RESULTS
Days with a nasogastric tube (p < 0.01), days until solid food was tolerated (p < 0.05), and hospital stay (p < 0.001) were increased in delayed compared to non-delayed patients. The total and incremental integrated peptide responses of motilin and GLP-1 were similar, but the responses of neurotensin and PYY were reduced, in delayed compared to non-delayed patients, whether considered on clinical grounds or by measured GER (p < 0.05-0.005).


CONCLUSIONS
Neurotensin and PYY slow the rate of gastric emptying in humans. Therefore, our findings suggest that reduced hormone responses were the consequence of DGE arising from delayed delivery of nutrients to the distal intestine where the endocrine cells secrete neurotensin and PYY reside.
Strömmer
Lisa
L
Center for Surgical Sciences, Stockholm, Sweden. Lisa.Strommer@cfss.ki.se
Räty
Sari
S
Hennig
Rene
R
Adrian
Thomas E
TE
Friess
Helmut
H
Böttiger
Ylva
Y
Stanaitis
Juozas
J
Nordback
Isto
I
Sand
Juhani
J
Arnelo
Urban
U
D000082:Acetaminophen; D000368:Aged; D005260:Female; D005746:Gastric Emptying / Q000502:physiology*; D005768:Gastrointestinal Hormones / Q000097:blood*; D005934:Glucagon / Q000097:blood; D052216:Glucagon-Like Peptide 1; D006801:Humans; D008297:Male; D008875:Middle Aged; D009037:Motilin / Q000097:blood; D009496:Neurotensin / Q000097:blood; D010190:Pancreatic Neoplasms / Q000601:surgery; D016577:Pancreaticoduodenectomy / Q000009:adverse effects*; D010446:Peptide Fragments / Q000097:blood; D019894:Peptide YY / Q000097:blood; D011446:Prospective Studies; D011498:Protein Precursors / Q000097:blood
D005768:Gastrointestinal Hormones; D010446:Peptide Fragments; D011498:Protein Precursors; D019894:Peptide YY; D000082:Acetaminophen; D009496:Neurotensin; D009037:Motilin; D052216:Glucagon-Like Peptide 1; D005934:Glucagon