The effect of esophagectomy on absorption in man: clinical and metabolic observations

Abstract

Summary In seven patients (six with carcinoma of the esophagus) with prior normal absorption, distal or near total esophagectomy resulted in malabsorption of fat, decreased appetite, gastric stasis, post-prandial discomfort, and loose and frequent bowel movements. Tumor per se, mediastinal radiation, transection of the cervical esophagus, or esophageal bypass by colon transplant had no significant effect on absorption. These conclusions are supported by the finding of fat malabsorption in five of seven additional patients studied after esophagectomy who gave no clinical history of altered bowel function prior to this procedure. Fecal nitrogen and potassium losses following esophagectomy were often increased but the changes were usually small; fecal sodium was usually normal as were xylose and vitamin B 12 absorption. Roentgenological studies following esophagectomy revealed marked gastric stasis (despite a drainage procedure) and small bowel changes of mild to moderate degree, characterized mainly by delayed transit time and ileal stasis. Follow-up studies indicated that the steatorrhea, anorexia, gastric stasis, and small bowel changes tended to persist for many months or years in the majority of the subjects who were followed. Patients with postesophagectomy steatorrhea were then studied in an effort to elucidate the etiology of this malabsorption. Histological examination of small bowel mucosa from seven cases revealed the presence of villi with normal epithelial cells. A gluten-free diet was without effect in two affected individuals. Administration of pancreatic and bile extracts or various antibiotics to a number of subjects did not consistently improve the steatorrhea. The evidence suggests that the malabsorption is not the result of impaired secretion of digestive juices, a blind loop syndrome, villous atrophy, or lymphatic obstruction. Medium chain triglycerides improved the steatorrhea and decreased the frequency of bowel movements in all patients tested. The etiology of the malabsorption remains uncertain although it is probably related to some unknown effect of the bilateral thoracic vagotomy accompanying esophagectomy.