Adaptive Gastrointestinal Hormone Changes after Gastric Resection

Abstract

Circulating alimentary hormones were measured following a standardized meal in 10 patients after partial distal gastrectomy and 12 patients after total gastrectomy, both groups reconstructed by Billroth-II anastomosis, and in 9 age-matched healthy controls. Patients underwent resection for gastric cancer and were studied 45 ± 10 months after surgery. At the time of study, the patients had adapted well to surgery and no longer exhibited the symptoms of dumping seen immediately postoperatively. In contrast, the total gastrectomy patients exhibited severe symptoms of reflux esophagitis. The nutritional states of the patients, evaluated by measurement of rapid turnover proteins in serum, was impaired in proportion to the degree of gastric resection. Basal gastrin levels were reduced by partial (p < 0.05) and total gastrectomy (p < 0.01). Postprandial responses of both gastrin and pancreatic polypeptide were abolished following either partial gastrectomy or total gastrectomy (all p < 0.001). Glucose-dependent insulinotropic peptide and motilin were relatively normal after both procedures. In contrast, early cholecystokinin responses were increased 2-fold after partial gastrectomy (p < 0.05) and 3-fold after total gastrectomy (p < 0.001). Postprandially, a large increase in neurotensin levels and a moderate increase in peptide YY were seen after both partial and total gastrectomy (all p < 0.01). Fasting peptide YY levels were also increased after total gastrectomy (p < 0.01). The late adaptive changes in alimentary hormone secretion may help to compensate for loss of gastric motor function which accompanies gastric resection. On the other hand these hormonal changes may exacerbate the esophageal reflux seen following gastrectomy.