Gastric Emptying and Sieving of Solid Food and Pancreatic and Biliary Secretion after Solid Meals in Patients with Truncal Vagotomy and Antrectomy

Abstract

This study was undertaken to answer two questions: (a) does antrectomy disturb sieving or grinding of solid food, or both, and (b) how abnormal are jejunal flows and concentrations of pancreatic enzymes and bile salts after a meal of solid food. Six normal subjects and 9 subjects with truncal vagotomy plus antrectomy were intubated with a triple-lumen tube attached to a bubble trap sited in the jejunum, 60 cm from the stomach. All subjects ate a meal of 100 ml of H2O, 60 g of beefsteak, and 30 g of 99mTc-liver diced into 10-mm cubes. By previously validated techniques, the tube-bubble trap system allowed comparison of the rate of passage of 99mTc-liver particles smaller than 1 mm through the jejunum with the rate of entry of all sizes of eaten 99mTc-liver into the intestine described by gamma camera. The tube system also measured concentrations and rates of passage of enzymes and bile salts. 99mTc-liver emptied very rapidly from the stomach in the first 50 min in most subjects with truncal vagotomy plus antrectomy and thereafter emptied slowly, while in the normal subjects there was a 30 min lag before a steady, slow rate of emptying. Nearly 30% of the 99mTc-liver that emptied into the intestine in the subjects with truncal vagotomy plus antrectomy was larger than 1 mm, but in the normal subjects less than 3% of the liver entered the intestines as larger particles. In this study with a solid meal, jejunal flows in the subjects with truncal vagotomy plus antrectomy were lower than normal, and concentrations of bile salts and pancreatic enzymes were close to normal.