Effects of erythromycin and metoclopramide on surgical patients with acute gastroparesis

Abstract

We explored the effect of intravenous erythromycin and metoclopramide on gastric emptying in patients with acute gastroparesis who had undergone Billroth 1 resection (BI) for gastric antral carcinoma or had acute pancreatitis (AP). We studied 15 patients with acute gastroparesis (8 with AP, 7 following BI), who received intravenous metoclopramide (0.2mg/kg) B.I.D. for 4 consecutive days. After 24hr, the patients who did not respond to metoclopramide were given intravenous erythromycin (3mg/kg) B.I.D. for 4 consecutive days. All patients underwent scintigraphic assessment of gastric, emptying (GE) before and after metoclopramide as well as after erythromycin using a 99mTc-sulfur colloid radio-labeled non nutrient liquid meal. Gastric half-emptying time (T1/2), residual percentage at 2 hr (RP), symptoms score (SS) as well as amount of nasogastric output (NGO) were adopted. GE in 4 patients with AP after metodopramide was more rapid (T1/2 93.2 +/-45.7rain vs 132 5 +A47.6min, and RP 64.6+/-27.5% vs 87.1 +/-11.6%, p 0.05). These 11 patients were given intravenous erythromycin. GE markedly accelerated and the amount of gastric output and SS significantly reduced compared to before erythromycin, in 4 patients with AP (T1/2 47.8 + A2 6rain vs 135 8 + / 1 4 1 min, RP 28.8 +/-4.1% vs 93.3 + A 4.5%, NGO 312 5 +/-62.9ml vs 1040.0+/-177.2ml, and SS 3 .8+/-1 .7 vs 6 .2+A2.0, p<0.O1), in patients with BI (T]/2 61 +/-21.7rain vs 106.0 +A18.7min, RP 50.0 +/-15.6% vs 865 +/-4. 1%, NGO 4333 +/]81.7ml vs 932.0 +/-70.5 ml, and SS 4 0 +/-1.5 vs 6.4 +/1.7, p < 0 01). One patient with BI discontinued erythromycin due to vomiting, 2 patients with BI did not respond to erythromycin. These three patients were treated with intravenous fluids only until symptoms resolved on 16th, 20th and 13th days respectively. Both erythromycin and metoclopramide significantly enhance GE in many patients with AP induced acute gastroparesis, and improves patient symptoms. Erythromycin was effective in the majority of patients with acute gastroparesis following B1 for antral cancer, but metoclopramide was not. We suggested that acute gastroparesis following BI resection and AP might be attnhuted to different mechanisms. Acute gastroparesis following BI resection may be a selflimiting disorder.