An impaired accommodation of the proximal stomach to a meal is associated with symptoms after distal gastrectomy

The aim of this study was to assess gastric emptying and postprandial proximal gastric tone variations depending on the presence of postoperative symptoms after Billroth II gastrectomy (BII). A total of 16 consecutive patients were prospectively studied 10 ± 3 months after distal gastrectomy for antral cancer. No evidence of cancer recurrence was detected at the time of the study. Ten patients were asymptomatic after surgery, whereas six patients were considered as symptomatic because of at least one weekly epigastric pain, postprandial fullness, nausea, or vomiting. The fasting fundus volume and tone, the onset of a gastric relaxation after a standard 200-kcal liquid meal, and the characteristics of this relaxation (delay of occurrence, amplitude) were determined with a barostat. Patient results were compared to normal values obtained in 12 healthy volunteers. Gastric emptying studies were performed in all patients using the C 13 acid octanoic breath test after a 250-kcal meal. In the patients, both fasting fundus tone (BII 7.0 ± 0.5, controls 8.4 ± 2.4 mm Hg) and volume (BII 108 ± 11, controls 119 ± 29 ml) were not different from controls. Fasting fundus tone was lower in asymptomatic patients than in symptomatic patients (6.5 ± 0.4 vs 8.1 ± 0.5 mm Hg, p < 0.04). Gastric relaxation was observed immediately after the meal in all asymptomatic patients as well as in controls. In contrast, gastric relaxation occurred in only two of six symptomatic patients ( p < 0.01); when it occurred it was delayed by the meal and was observed only 23 ± 1 min after food intake. When a relaxation occurred, its amplitude was higher than that observed in controls both in asymptomatic and symptomatic patients (294 ± 21 vs 179 ± 53 ml, p < 0.02). After distal gastrectomy, gastric accommodation is impaired ( i.e., absent or delayed) in symptomatic patients. When relaxation exists in these patients, its amplitude is higher than in control subjects.