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The role of gastric stasis in the genesis of gastric ulceration following fundoplication

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Abstract

Gastric ulceration is a cause of significant morbidity in approximately 3% of patients undergoing fundoplication. The etiology of this complication remains unsettled. A patient who presented with gastric ulceration following fundoplication is described. Gastric emptying of solids was markedly delayed (28% retention at 120 minutes; normal range, 3–17%). The integrated gastrin response to 180 g of lean meat (368%) demonstrated marked derangement of the antrat gastrin mechanism (normal, 44±8%). Metoclopramide therapy resulted in normalization of gastric emptying (13% retention at 120 minutes), while the integrated gastrin response showed a decided decrease (257%). This patient clearly implicates gastric stasis and hypergastrinemia secondary to vagal dysfunction as a contributing factor in the etiology of gastric ulceration following fundoplication. The question as to whether this vagal dysfunction is a preexisting condition or the result of operative manipulations remains unresolved.

Résumé

Chez 30% des sujets qui subissent une fundoplicature se manifeste une ulcération gastrique dont l'étiologie reste inconnue.

Un cas de ce type est ici rapporté. Chez le sujet affecté l'évacuation gastrique des solides était retardée (28% de rétention après 120 minutes alors que le taux normal varie de 3 à 17%). Chez lui le taux de gastrine après repas d'épreuve à l'aide de 180 grammes de vian de maigre (368%) démontrait une perturbation très nette du mécanisme gastrinique antral (taux normal 44%±8%). Le recours au traitement par la métoclopramide entraina le retour à la normale de l'évacuation gastrique (13% de rétention après 120 minutes) cependant que la réponse gastrinique au repas d'épreuve s'atténuait (257%). En conclusion chez cet opéré la stase gastrique et l'hyper gastrinémie secondaires a une atteinte fonctionnelle vagale peuvent être considérés comme les causes éventuelles de l'ulcère gastrique post opératoire; mais il est impossible de savoir si cette atteinte fonctionnelle existait avant l'intervention ou si elle feut secondaire aux manipulations opératoires.

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References

  1. Sifers, E.C., Taylor, T.L., Rick, G.G., Hartman, C.R., Trebar, L.L.: The role of gastrin in the treatment of sliding hiatal hernia with reflux using the reefing method of fundoplication. Surg. Gynecol. Obstet.143:376, 1976

    Google Scholar 

  2. Bushkin, E.L., Woodward, E.R., O'Leary, J.P.: Occurrence of gastric ulcer after Nissen fundoplication. Am. Surg.42:821, 1976

    Google Scholar 

  3. McGuigan, J.E., Trudeau, W.L.: Difference in rates of gastrin release in normal persons and patients with duodenal ulcer disease. N. Engl. J. Med.288:64, 1973

    Google Scholar 

  4. Ivey, K.J., DenBesten, L., Clifton, J.A.: Effect of bile salts on ionic movement across the human gastric mucosa. Gastroenterology59:683, 1970

    Google Scholar 

  5. Capper, W.M., Butler, T.J., Kilby, J.O.: Reversal of non-Addisonian achlorhydria by a Roux-en-Y loop. Gut8:612, 1967

    Google Scholar 

  6. Dragstedt, L.R., Harper, P.V., Toybee, E.B., Woodward, E.R.: Section of the vagus nerves to the stomach in the treatment of peptic ulcer: Complications and end results after 4 years. Ann. Surg.126:687, 1947

    Google Scholar 

  7. Bremner, C.G.: Gastric ulcer after the Nissen fundoplication: A complication of alkaline reflux. S. Afr. Med. J.51:791, 1977

    Google Scholar 

  8. Bremner, C.G.: Gastric ulceration after the fundoplication operation for gastroesophageal reflux. Surg. Gynecol. Obstet.148:62, 1979

    Google Scholar 

  9. DeMeester, T.R., Johnson, L.F., Joseph, G.T., Toscano, M.S., Hall, A.W., Skinner, D.B.: Patterns of gastroesophageal reflux in health and disease. Ann. Surg.184:459, 1976

    Google Scholar 

  10. Csendes, A., Henriquez, A.: Gastric emptying in patients with reflux esophagitis or benign strictures of the esophagus secondary to reflux compared to controls. Scand. J. Gastroenterol.13:205, 1978

    Google Scholar 

  11. Hinder, R.A., Kelly, K.A.: Canine gastric emptying of solids and liquids. Am. J. Physiol.233:E335, 1977

    Google Scholar 

  12. Behar, J., Ramsby, G.: Gastric emptying and antral motility in reflux esophagitis. Gastroenterology74:253, 1978

    Google Scholar 

  13. McCallum, R.W., Berkowitz, D.M., Lerner, E.: Gastric emptying in patients with gastroesophageal reflux. Gastroenterology80:285, 1981

    Google Scholar 

  14. McCallum, R.W., Mensh, R., Lange, R.: Definition of the gastric emptying abnormality present in gastroesophageal reflux patients. Gastroenterology80: 1226, 1981

    Google Scholar 

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Authors and Affiliations

  1. Departments of Surgery and Medicine, University of Florida, Gainesville, Florida, USA

    James W. Maher M.D. & James J. Cerda M.D.

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  1. James W. Maher M.D.
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  2. James J. Cerda M.D.
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Maher, J.W., Cerda, J.J. The role of gastric stasis in the genesis of gastric ulceration following fundoplication. World J. Surg. 6, 794–797 (1982). https://doi.org/10.1007/BF01655378

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  • DOI: https://doi.org/10.1007/BF01655378

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