Post-surgical and obstructive gastroparesis

Abstract

Post-surgical gastroparesis (PSG) is recognized as a consequence of vagal nerve injury following upper abdominal surgery. It has been well documented following vagotomy for peptic ulcer surgery. With the increasing role of surgical treatment in the management of GERD and morbid obesity, PSG is now being diagnosed after fundoplication and bariatric surgery. PSG has also been reported after heart and lung transplantation, possibly due to opportunistic viral infection or motor-inhibitory effects of the immunosuppressive drugs, in addition to vagal nerve injury. Initial postoperative management of PSG should be conservative as many symptoms following abdominal surgery resolve with time. This occurs possibly because the enteric nervous system is able to adapt to the loss of vagal input or vagal reinnervation occurs. Persistent symptoms are difficult to manage and require a multidisciplinary team approach. Gastric electrical stimulation has shown promise in small series.

Down-regulation of ghrelin receptors in the small intestine delays small intestinal transit in vagotomized rats

“…In esophageal and gastric surgery, there is often a delay in gastrointestinal motility, and trauma of the vagal nerve sometimes is involved (20,21,28). When the vagal nerve is injured, the delay in gastrointestinal transit increases (29)(30)(31).…”

“…Ghrelin (20,40 or 80 µg/kg) was administered intraperitoneally (i.p.) to the vagotomized and control rats immediately after injection of 0.2 ml trypan blue semi-liquid test meal via the catheter.…”

“…Better understanding of the effects of ghrelin on small intestinal transit and smooth muscle contraction and the association of expression levels of ghrelin receptors may help explain the phenomenon of delayed small intestinal transit after surgery involving trauma of the vagal nerve (20,21).…”

Lung Transplantation for Pulmonary Sarcoidosis

“…Although more commonly seen as a result of gastric surgery there has been a recent increase in the reported incidence of vagus nerve injury following fundoplication surgery and bariatric surgery. However, there have been reports of cases in transplantation also (Shafi and Pasricha 2007;Paul, Escareno et al 2009)with the incidence reported to be of the order of five percent. Most cases can be managed conservatively; however there may be significant problems post lung transplantation in terms of maintaining adequate immunosuppression and nutritional absorption.…”

Acute Gastric Dysfunction After Catheter Ablation of Atrial Fibrillation

“…Symptoms of gastroparesis are variable, nonspecific and usually include nausea, vomiting, bloating, early satiety and abdominal pain [2]. It has many potential etiologies.…”