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Role of vagal dysfunction in motility and transit disorders of jejunal roux limb after roux-en-Y gastrojejunostomy

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Abstract

After a Roux-en-Y gastrojejunostomy patients frequently complain about abdominal pain, fullness, nausea and vomiting, ie, the Roux-en-Y syndrome. Stasis in the Roux limb due to disordered motility is known to be a cause of these complaints. The aim of the present study was to determine whether vagal denervation contributes to the development of motility disturbances and stasis in the Roux limb. Forty-seven patients with a Roux-en-Y gastrojejunostomy after partial gastrectomy were studied. A truncal vagotomy had been performed in 26 of these 47 patients. Transit through the Roux limb was evaluated by radionuclide studies, motility in the Roux limb was studied by manometry, and vagal function was tested by measuring the pancreatic polypeptide response to an insulin-induced hypoglycemia (PP test). On the basis of the PP test patients were classified as having (1) normal, (2) moderately impaired, and (3) severely impaired vagal function. The PP test showed that two of the 26 patients subjected to vagotomy had a moderately impaired vagal function, the other 24 all had a severely impaired vagal function. In the patients not subjected to a vagotomy, vagal function was disturbed in 11 of the 21 patients. Motility disturbances were not observed more frequently in patients with either moderately or severely impaired vagal function than in patients with normal vagal function. Stasis in the Roux limb was seen even more frequently in patients with a normal vagal function than in patients with a severely impaired vagal function. The results of this study indicate that vagal denervation of the Roux limb is not the cause of motility and transit disorders in the Roux limb.

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References

  1. Gustavsson S, Ilstrup DM, Morrison P, Kelly KA: Roux-Y stasis syndrome after gastrectomy. Am J Surg 155:490–494, 1988

    Google Scholar 

  2. Britton JP, Johnston D, Ward DC, Axon ATR, Barker MCJ: Gastric emptying and clinical outcome after Roux-en-Y diversion. Br J Surg 74:900–904, 1987

    Google Scholar 

  3. Ferguson GH, MacLennan I, Taylor TV, Torrance HB: Outcome of revisional gastric surgery using a Roux-en-Y biliary diversion. Br J Surg 77:551–554, 1990

    Google Scholar 

  4. Van der Mijle HCJ, Beekhuis H, Bleichrodt RP, Kleibeuker JH: Transit disorders of the gastric remnant and Roux-limb after Roux-en-Y gastrojejunostomy; relation with symptomatology and vagotomy. Br J Surg 80:60–64, 1993

    Google Scholar 

  5. Mathias JR, Fernandez A, Sninsky CA, Clench MH, Davis RH: Nausea, vomiting, and abdominal pain after Roux-en-Y anastomosis: Motility of the jejunal limb. Gastroenterology 88:101–107, 1985

    Google Scholar 

  6. Azpiroz F, Malagelada J-R: Gastric tone measured by an electronic barostat in health and postsurgical gastroparesis. Gastroenterology 92:934–943, 1987

    Google Scholar 

  7. Stadaas J, Aune S: Intragastric pressure/volume relationship before and after vagotomy. Acta Chir Scand 136:611–615, 1970

    Google Scholar 

  8. Woodward A, Schu W, Wojtowycz AR, Sillin LF: Gastric emptying of solids after Roux-en-Y gastrectomy: Is extragastric vagal innervation important? Surgery 110:793–798, 1991

    Google Scholar 

  9. Hocking MP, Vogel SB, Falasca CA, Woodward ER: Delayed gastric emptying of liquids and solids following Roux-en-Y biliary diversion. Ann Surg 194:494–501, 1981

    Google Scholar 

  10. Vogel SB, Vair DB, Woodward ER: Alterations in gastrointestinal emptying of 99m-technetium labeled solids following sequential antrectomy, truncal vagotomy and Roux-Y gastroenterostomy. Ann Surg 198:506–515, 1983

    Google Scholar 

  11. Morrison P, Miedema BW, Kohler L, Kelly KA: Electrical dysrhythmias in the Roux jejunal limb: Cause and treatment. Am J Surg 160:252–256, 1990

    Google Scholar 

  12. Vantrappen G, Coremans G, Janssens J, Mantides A, Vanden Borre F: Inversion of the slow-wave frequency gradient in symptomatic patients with Roux-en-Y anastomoses. Gastroenterology 101:1282–1288, 1991

    Google Scholar 

  13. Jansen EH: Clinical value of vagus nerve integrity testing by pancreatic polypeptide. Doctoral thesis. Leiden, Netherlands, ICG Printing, 1990

    Google Scholar 

  14. Ruckley CV: A study of the variations of the abdominal vagi. Br J Surg 51:569–573, 1964

    Google Scholar 

  15. Schwartz TW: Pancreatic polypeptide: A hormone under vagal control. Gastroenterology 85:1411–1425, 1983

    Google Scholar 

  16. Lamers CBHW, van Leusen R, de Jong AJL, van Leer E, Diemel CM, Peetoom JJ, Jansen JBMJ: Cholinergic regulation of pancreatic polypeptide secretion in chronic renal failure. Clin Endocrinol 21:23–31, 1984

    Google Scholar 

  17. Schwartz TW, Holst JJ, Fahrenkrug J, Lindkaer Jensen S, Nielsen OV, Rehfeld JF, Schaffalitzky De Muckadell OB: Vagal, cholinergic regulation of pancreatic polypeptide secretion. J Clin Invest 61:781–789, 1987

    Google Scholar 

  18. Van der Mijle HCJ, Beekhuis H, Bleichrodt RP, Kleibeuker JH: Cisapride in treatment of Roux-en-Y syndrome. Dig Dis Sci 36:1691–1696, 1991

    Google Scholar 

  19. Kleibeuker JH, Beekhuis H, Piers DA, Schaffalalitzky de Muckadell OB: Retardation of gastric emptying of solid food by secretin. Gastroenterology 94:122–126, 1988

    Google Scholar 

  20. Kellow JE, Borody TJ, Phillips SF, Tucker RL, Haddad AC: Human interdigestive motility: Variations in patterns from esophagus to colon. Gastroenterology 91:386–395, 1986

    Google Scholar 

  21. Kerlin P, Phillips S: Variability of motility of the ileum and jejunum in healthy humans. Gastroenterology 82:694–700, 1982

    Google Scholar 

  22. Stanghellini V, Camilleri M, Malagelada J-R: Chronic idiopathic intestinal pseudoobstruction: Clinical and intestinal manometric findings. Gut 28:5–12, 1987

    Google Scholar 

  23. Camilleri M: Jejunal manometry in distal subacute mechanical obstruction: Significance of prolonged simultaneous contractions. Gut 30:468–475, 1989

    Google Scholar 

  24. Summers RW, Anuras S, Green J: Jejunal manometry patterns in health, partial intestinal obstruction, and pseudoob-struction. Gastroenterology 85:1290–1300, 1983

    Google Scholar 

  25. Fich A, Neri M, Camilleri M, Kelly KA, Phillips SF: Stasis syndromes following gastric surgery: Clinical and motility features of 60 symptomatic patients. J Clin Gastroenterol 12:505–512, 1990

    Google Scholar 

  26. Floyd JC, Fajans SS, Pek S, Chance RE: A newly recognized pancreatic polypeptide; plasma levels in health and disease. Recent Prog Horm Res 33:519–570, 1977

    Google Scholar 

  27. Floyd JC, Fajans SS, Pek S: Regulation in healthy subjects of the secretion of human pancreatic polypeptide, a newly recognized pancreatic islet polypeptide. Trans Am Physicians 89:146–158, 1976

    Google Scholar 

  28. Van der Mijle HCJ, Kleibeuker JH, Kleibeuker MD, Limburg AJ, Bleichrodt RP, Beekhuis H, van Schilfgaarde R: Manometric and scintigraphic studies of the relation between motility disturbances in the Roux-limb and the Roux-en-Y syndrome. Am J Surg 166:11–17, 1993

    Google Scholar 

  29. Thompson DG, Ritchie HD, Wingate DL: Patterns of small intestinal motility in duodenal ulcer patients before and after vagotomy. Gut 23:517–523, 1982

    Google Scholar 

  30. Weisbrodt NW, Copeland EM, Moore EP, Kearley RW, Johnson LR: Effect of vagotomy on electrical activity of the small intestine of the dog. Am J Physiol 228:650–654, 1975

    Google Scholar 

  31. Hall KE, El-Sharkawy TY, Diamant NE. Vagal control of canine postprandial upper gastrointestinal motility. Am J Physiol 250:G501–G510, 1986

    Google Scholar 

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Authors and Affiliations

  1. From the Departments of Surgery, Gastroenterology and Nuclear Medicine, University Hospital, Groningen

    Huub C. J. Van Der Mijle MD,  Jan H. Kleibeuker MD, Abraham J. Limburg MD, Henk Beekhuis PhD, Cornelis B. H. W. Lamers MD & Reinout Van Schilfgaarde MD

  2. Department of Gastroenterology, University Hospital, Leiden, The Netherlands

    Huub C. J. Van Der Mijle MD,  Jan H. Kleibeuker MD, Abraham J. Limburg MD, Henk Beekhuis PhD, Cornelis B. H. W. Lamers MD & Reinout Van Schilfgaarde MD

Authors
  1. Huub C. J. Van Der Mijle MD
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  2. Jan H. Kleibeuker MD
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  3. Abraham J. Limburg MD
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  4. Henk Beekhuis PhD
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  5. Cornelis B. H. W. Lamers MD
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  6. Reinout Van Schilfgaarde MD
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This work was supported by the Jan Kornelis de Cock-Stichting.

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Van Der Mijle, H.C.J., Kleibeuker, J.H., Limburg, A.J. et al. Role of vagal dysfunction in motility and transit disorders of jejunal roux limb after roux-en-Y gastrojejunostomy. Digest Dis Sci 39, 827–833 (1994). https://doi.org/10.1007/BF02087430

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  • DOI: https://doi.org/10.1007/BF02087430

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