Clinical evaluation of long-term srvival after total gastrectomy

Koga, Shigemasa; Nishimura, Okitsugu; Iwai, Noritake; Kawakami, Kiyoshi; Takeuchi, Tsutomu; Hinohara, Toru; Okamoto, Tsuneyuki

doi:10.1016/0002-9610(79)90335-0

Cited by 21 publications

(5 citation statements)

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“…2). Bone disease after total gastrectomy may occur [32,34,35]. The calcium requirement seems to be normal, but insufficient intake of calcium and vitamin D have been demonstrated after partial gastrectomy and may also have relevance to the situation after total gastrectomy [36,37].…”

Section: Vitamins and Mineralsmentioning

confidence: 99%

Intestinal function after total gastrectomy and possible consequences of gastric replacement

Olbe

Lundell

1987

World j. surg.

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About half of the patients subjected to total gastrectomy experience weight loss. Malabsorption, particularly fat malabsorption, is a common feature after total gastrectomy. This may be due to shortened intestinal transit time and small bowel bacterial overgrowth, but is less often due to diarrhea or pancreatic exocrine insufficiency. Malabsorption is not closely related to weight loss, which is mainly caused by recurrent malignant diseases and a low postoperative calorie intake. The low calorie intake persists in half of the patients despite supervision of the patients by clinical nutritionists at the outpatient clinic. Roux-en-Y reconstruction of the esophago-intestinal canal has minimized the problem of postoperative reflux esophagitis. Severe postprandial symptoms are uncommon although epigastric oppression and fullness is an obligatory feature in the immediate postoperative period but successively vanishes in half of the patients.Gastric replacement by various enteric reservoirs has been used to improve nutrition after total gastrectomy. The effect of gastric replacement is, however, uncertain since no prospective, randomized studies are available. A gastric substitute seems to have only a marginal effect on meal size, daily caloric intake, and weight gain. A reservoir function of gastric substitutes has been documented but the effect on intestinal transit time is unknown. Stagnation of intestinal contents in a gastric replacement is common, but its significance for bacterial overgrowth, malabsorption, and clinical outcome remains to be determined.

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Section: Vitamins and Mineralsmentioning

confidence: 99%

Intestinal function after total gastrectomy and possible consequences of gastric replacement

Olbe

Lundell

1987

World j. surg.

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“…It is known that osteopenia is induced after gastric resection in patients (Koga et al 1979;Nilas et al 1985). Absence of gastric acid after this operation may impair insoluble Ca absorption because gastric acid is the most important factor for solubilization of insoluble Ca salts.…”

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confidence: 99%

Ingestion of the soluble dietary fibre, polydextrose, increases calcium absorption and bone mineralization in normal and total-gastrectomized rats

2000

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We previously demonstrated that feeding a highly fermentable and water-soluble dietary fibre, guar-gum hydrolysate (GGH) increased intestinal absorption of insoluble Ca salts in total-gastrectomized rats. In the present study, we examined the effects of feeding a less fermentable and water-soluble fibre, polydextrose (PD), on Ca absorption and bone mineralization in the normal and total-gastrectomized rats in comparison with the effects of GGH. Apparent Ca absorption was severely lowered by gastrectomy, and PD feeding (50 g/kg diet) partially restored the reduction of Ca absorption similarly to GGH feeding (50 g/kg diet). PD feeding also increased the Ca absorption in normal rats, but not GGH feeding. Femur Ca concentration was reduced with gastrectomy. Feeding PD for 21 d increased the bone Ca concentration in both normal and gastrectomized rats, but GGH feeding did not. In rats fed PD, pH of the caecal contents was lower than in rats fed fibre-free and GGH diets; however, soluble Ca concentration in the caecal contents was not different between the diet groups. Short-chain fatty acid concentrations were much lower in the PD groups than in the GGH groups. We also examinedin vitroCa absorption by using everted sacs of the small intestine. Addition of PD to the serosal medium of the ileal sacs increased Ca absorption, but addition of GGH did not. These results suggest that the small intestine rather than the large intestine is responsible for the increase in Ca absorption in rats fed PD, and suggests that the mechanism for the increase by PD may be different from that by GGH.

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“…However, both parameters may not be suitable to assess malnutrition after total gastrectomy, since hypoproteineniia in gastrectomized pigs improved during the study, although gastrectomized pigs remained under weight. The same observation has been made in patients in whom total protein and albumin levels are reduced after total gastrectomy, but increase with time and are eventually in the normal range [8,9,36]. Therefore, total protein and albumin may not be reliable as parameters to evaluate malnutrition after total gastrectomy.…”

Section: Body Weight [Kg]mentioning

confidence: 79%

Reduced Food Intake and Impaired Food Utilization Result in Weight Loss after Total Gastrectomy in Pigs

Maier¹,

Zittel²,

Becker³

1996

Dig Surg

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Total gastrectomy often results in considerable weight loss and malnutrition. Studies indicate that decreased food intake might contribute to weight loss after total gastrectomy, but fed matched controls were not used in those studies. Serum proteins are used as parameters of malnutrition but might not be adequate to assess malnutrition after total gastrectomy. We measured food intake, weight gain per kilojoule of food intake, body weight, serum protein and albumin in gastrectomized and sham-operated fed matched minipigs over a period of 12 months. Total gastrectomy resulted in reduced food intake, reduced weight gain per kilojoule of food intake and in underweight, while fed matched sham-operated controls increased their body weight as did unoperated controls. Serum protein and albumin were initially decreased after total gastrectomy, but increased with time and were not different from sham-operated controls by the end of the study. Our data indicate that reduced food intake and a reduced efficiency to convert food into body weight result in body weight loss after total gastrectomy. This suggests that a hypercaloric food intake should be recommended after total gastrectomy, while serum proteins might not correctly reflect malnutrition after total gastrectomy.

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Clinical evaluation of long-term srvival after total gastrectomy

Cited by 21 publications

References 1 publication

Intestinal function after total gastrectomy and possible consequences of gastric replacement

Intestinal function after total gastrectomy and possible consequences of gastric replacement

Ingestion of the soluble dietary fibre, polydextrose, increases calcium absorption and bone mineralization in normal and total-gastrectomized rats

Reduced Food Intake and Impaired Food Utilization Result in Weight Loss after Total Gastrectomy in Pigs

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