The effect of vagotomy and drainage on the small bowel flora

Browning, G. G. P.; Buchan, Kevin; MacKay, C

doi:10.1136/gut.15.2.139

Cited by 36 publications

(4 citation statements)

References 25 publications

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“…After proximal gastric vagotomy, however, resulting in a similar elevation of gastric pH, no change of jejunal microflora was found [59]. The same pattern is seen in clinical studies [16,58,60]. Changes of the anatomy and the parasympathetic innervation of the antroduodenal region after surgery may interfere with motility and clearance, and thus predispose to colonization with Gram-negative bacilli in the small bowel.…”

Section: Surgerymentioning

confidence: 52%

The Pathogenesis of Gastrointestinal Bacterial Overgrowth

Husebye

2005

Chemotherapy

137

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The normal indigenous intestinal microflora consists of about 10¹⁵ bacteria that under physiological conditions reside mainly in the lower gastrointestinal tract. Bacterial overgrowth implies abnormal bacterial colonization of the upper gut, resulting from failure of specific defense mechanisms restricting colonization under physiological conditions. At present two types of bacterial overgrowth with defined pathogenesis can be distinguished: (1) gastric overgrowth with upper respiratory tract microflora resulting from selective failure of the gastric acid barrier, and (2) gastrointestinal overgrowth with Gram-negative bacilli (enteric bacteria) resulting from failure of intestinal clearance. Helicobacter pylori-induced gastritis of the oxyntic mucosa is the main cause of acquired failure of the gastric acid barrier, which is common among the healthy elderly. Intestinal clearance may fail as the result of impaired intestinal peristalsis or anatomical abnormalities that alter luminal flow. Impaired peristalsis is associated with conditions interfering with intestinal neuromuscular function including myopathic, neuropathic, autoimmune, infectious, inflammatory, metabolic, endocrine, and neoplastic diseases. Anatomical abnormalities are mainly the result of gastrointestinal surgery, intestinal diverticula or fistula. Combined failure of intestinal clearance and the gastric acid barrier results in more severe colonization with Gram-negative bacilli. Gram-negative bacilli are uncommon in the upper gut of otherwise healthy individuals with gastric hypochlorhydria, being acquired (H. pylori) or drug-induced. Significant bacterial overgrowth with Gram-negative bacilli is a rational in the search for an explanation to optimize clinical management. The clinical significance of colonization with upper respiratory tract microflora remains unclear. Translocation of live bacteria, their metabolic products, or antigens from a small bowel colonized by Gram-negative bacilli play a role in the pathogenesis of spontaneous bacterial peritonitis in hepatic disease and in certain types of sepsis, indicating that further studies can point to new patient populations with potential benefit from medical treatment.

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Section: Surgerymentioning

confidence: 52%

The Pathogenesis of Gastrointestinal Bacterial Overgrowth

Husebye

2005

Chemotherapy

137

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“…Such predisposing factors include diabetes, scleroderma, intestinal pseudo-obstruction, prior surgery (eg, terminal ileal resection), diverticulosis or strictures of the small bowel. 205 Gastric surgery, in particular that involving a blind loop, is associated with a high prevalence of SBBO: up to 50% of patients with gastrojejunostomy and vagotomy compared with 5% of those with vagotomy and pyloroplasty, 206 although the clinical significance of this finding is unclear. 207 Authors have also reported a high prevalence of SBBO in situations associated with achlorhydria such as old age or medical therapy with proton pump inhibitors.…”

Section: Tests For Malabsorptionmentioning

confidence: 99%

Guidelines for the investigation of chronic diarrhoea in adults: British Society of Gastroenterology, 3rd edition

Arasaradnam

Brown

Forbes

et al. 2018

Gut

236

222

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Chronic diarrhoea is a common problem, hence clear guidance on investigations is required. This is an updated guideline from 2003 for the investigations of chronic diarrhoea commissioned by the Clinical Services and Standards Committee of the British Society of Gastroenterology (BSG). This document has undergone significant revision in content through input by 13 members of the Guideline Development Group (GDG) representing various institutions. The GRADE system was used to appraise the quality of evidence and grading of recommendations.

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“…Vagotomy and hemigastrectomy (7,8), scleroderma (9), diabetic autonomic neuropathy (10), and idiopathic intestinal pseudo-obstruction (11) are diseases characterized by impaired motor function of the intestine and are associated with abnormal proliferation of bacteria within the lumen of the small intestine. A specific mechanism…”

Section: Introductionmentioning

confidence: 99%

Altered myoelectric activity in the experimental blind loop syndrome.

Justus¹,

Fernández²,

Martin³

et al. 1983

J. Clin. Invest.

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A B S T R A C T Nutrient malabsorption and diarrhea are characteristic of the blind loop syndrome. Alterations in motility have been implicated as a cause of bacterial overgrowth, but the possibility that altered motility may result from alterations in the flora has not been explored. The purpose of this study was to characterize the myoelectric activity of the small intestine in the blind loop rat model. Eight groups of rats were studied: rats with self-filling blind loops, which develop bacterial overgrowth; rats with selfemptying blind loops, which are surgical controls that do not develop overgrowth; unoperated litter mates; rats with self-filling blind loops and unoperated controls treated with chloramphenicol, 200 mg/d i.p.; rats with surgically removed self-filling blind loops; operated control rats; and gnotobiotic rats with self-filling blind loops. In the untreated rats with self-filling blind loops, there was altered myoelectric activity characterized by an increased percentage of slow waves occupied by action potentials and by organized activity similar to the migrating action potential complex. Migrating action potential complex activity and percentage of slow waves occupied by action potentials were significantly decreased with chloramphenicol therapy; that decrease correlated with a decrease in aerobes and anaerobes. Migrating action potential complex activity was abolished in rats with surgically removed self-filling blind loops; they also showed a significant decrease in percentage of slow waves occupied by action potentials. Gnotobiotic rats with self-

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The effect of vagotomy and drainage on the small bowel flora

Cited by 36 publications

References 25 publications

The Pathogenesis of Gastrointestinal Bacterial Overgrowth

The Pathogenesis of Gastrointestinal Bacterial Overgrowth

Guidelines for the investigation of chronic diarrhoea in adults: British Society of Gastroenterology, 3rd edition

Altered myoelectric activity in the experimental blind loop syndrome.

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