title: Long-term effects of gastrectomy in patients with spirometry-defined COPD and patients at risk of COPD: a case-control study.
abstract: OBJECTIVE
  Comorbidities are characteristic of COPD. However, little is known about the secondary manifestations of COPD in the gastrointestinal tract. Therefore, we aimed to explore the long-term effects of gastrectomy in patients with spirometry-defined COPD or those at risk of COPD.
  
  
  METHODS
  Subjects included 87 patients either with COPD or at risk of COPD (symptomatic) who underwent gastrectomy between December 2003 and October 2013 (group A), and 174 patients either with COPD or at risk of COPD, matched by age (±5 years), sex, and forced expiratory volume in 1 second (FEV1) as percentage of predicted (FEV1% predicted) (±5%) (group B).
  
  
  METHODS
  All patients underwent routine blood chemistry and pulmonary function tests, arterial blood gas analysis, 6-minute walk test (6MWT), high-resolution chest computed tomography scans, and nutritional assessments.
  
  
  RESULTS
  The mean duration postgastrectomy was 18.3±15.4 years. The mean FEV1 and FEV1% predicted were 2.07±0.76 L and 74.6±24.5%, respectively. Univariate analysis indicated that group A patients had significantly lower body mass index, fat-free mass index, and serum hemoglobin and albumin concentration (all P=0.00), and walked a significantly shorter distance in the 6MWT (P<0.05). Multivariate linear regression analysis for the distance in the 6MWT indicated that increased residual volume (RV) to total lung capacity (TLC) as percentage of predicted (%RV/TLC) alone was an independent and significant predictor of reduced distances in the 6MWT.
  
  
  CONCLUSIONS
  We concluded that nutritional insufficiency in patients with COPD (or those at risk of COPD) who previously underwent gastrectomy might lead to hyperinflation and consequently, decreased exercise capacity.
authors.affiliation: Department of Respiratory Medicine, Tokyo Metropolitan Hiroo Hospital, Tokyo, Japan ; Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Tokyo, Japan.
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Saito
authors.affiliation: Department of Respiratory Medicine, Tokyo Metropolitan Hiroo Hospital, Tokyo, Japan ; Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Tokyo, Japan.
authors.forename: Koichiro
authors.initials: K
authors.lastname: Nomura
authors.affiliation: Department of Respiratory Medicine, Tokyo Metropolitan Hiroo Hospital, Tokyo, Japan ; Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Tokyo, Japan.
authors.forename: Shinji
authors.initials: S
authors.lastname: Abe
authors.affiliation: Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Tokyo, Japan ; Respiratory Care Clinic, Nippon Medical School, Tokyo, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Motegi
authors.affiliation: Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Tokyo, Japan ; Respiratory Care Clinic, Nippon Medical School, Tokyo, Japan.
authors.forename: Takeo
authors.initials: T
authors.lastname: Ishii
authors.affiliation: Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Tokyo, Japan ; Respiratory Care Clinic, Nippon Medical School, Tokyo, Japan.
authors.forename: Kumiko
authors.initials: K
authors.lastname: Hattori
authors.affiliation: Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Tokyo, Japan ; Respiratory Care Clinic, Nippon Medical School, Tokyo, Japan.
authors.forename: Yuji
authors.initials: Y
authors.lastname: Kusunoki
authors.affiliation: Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Tokyo, Japan.
authors.forename: Akihiko
authors.initials: A
authors.lastname: Gemma
authors.affiliation: Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Tokyo, Japan ; Respiratory Care Clinic, Nippon Medical School, Tokyo, Japan.
authors.forename: Kozui
authors.initials: K
authors.lastname: Kida
mesh_terms: D000368:Aged; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D015897:Comorbidity; D005080:Exercise Test; D017079:Exercise Tolerance; D005260:Female; D005541:Forced Expiratory Volume; D005743:Gastrectomy / Q000009:adverse effects; D006801:Humans; D007564:Japan / Q000453:epidemiology; D016014:Linear Models; D016015:Logistic Models; D008168:Lung / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D015596:Nutrition Assessment; D009752:Nutritional Status; D011237:Predictive Value of Tests; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology; D012307:Risk Factors; D013147:Spirometry; D013274:Stomach Neoplasms / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology / Q000601:surgery*; D013276:Stomach Ulcer / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome; D014797:Vital Capacity
keywords: 6-minute walk test; chronic obstructive pulmonary disease; nutritional insufficiency