The Impact and Clinical Implications of Gastric Surgery on the Gastric Conduction System

Abstract

Chronic symptoms of gastric dysfunction are common following gastric surgery, but the mechanisms underlying these have remained poorly understood. Disturbances of foregut motility are suspected to play a central role, however knowledge of how these abnormalities manifest and relate to symptoms requires elucidation. Emerging data suggests that abnormalities of the gastric conduction system are a common consequence of gastric surgery and may contribute to dysmotility and post-operative symptoms. This review provides a primer on the gastric conduction system. The normal physiology of the gastric conduction system and factors that influence resilience to surgery are outlined, together with focused discussion on three surgical procedures that impact post-operative gastric dysfunction: resection of the gastric pacemaker, resection or bypass of the pylorus, and vagotomy. The mechanistic pathways that underpin the clinical effects of these procedures are discussed. Future horizons are also evaluated, including newly established body surface gastric mapping techniques that provide a non-invasive method to detect changes in the gastric conduction system and relate these to symptoms in postoperative patients, with the goal of developing targeted interventions for prevention and therapy.

Non-invasive thoracoabdominal mapping of post-oesophagectomy conduit function

“…Gastric surgery modifies the electrical conduction system that coordinates contractions (15), with previous studies implicating abnormal electrophysiology in conduit dysfunction (3-5). However, reliable techniques to assess conduit function have been lacking.…”

“…Reduced frequency likely reflects resection of the native gastric pacemaker, leading to the development a new lower-frequency pacemaker (18). Low GA-RI likely reflects gastric neuromuscular dysfunction due to aberrant pacemaker recovery (6), while reduced meal responses could reflect loss of vagal input (15). While vagotomy is inevitable to allow lymph node harvest in cancer patients, evolving techniques offer vagal-sparing esophagectomies for non-malignant indications (eg.…”

“…No adverse reactions occurred. Gastric surgery modifies the electrical conduction system that coordinates contractions (15), with previous studies implicating abnormal electrophysiology in conduit dysfunction (3)(4)(5).…”

Principles and clinical methods of body surface gastric mapping: Technical review

“…BSGM is applied as an aid to the diagnosis of patients presenting with chronic gastric symptoms, which includes any patient with a suspicion of gastric or pan‐gut dysmotility. This also encompasses postoperative gastric dysfunction, where anatomical manipulations can induce pathological changes in the gastric conduction system 67 . The test offers potential utility in assessing for gastric dysrhythmia, neuromuscular disorders, myopathies, gastric outlet resistance, autonomic dysregulation, and to generally specify the origins of gut symptoms.…”

Can We Impact the Incidence and Outcomes of Barrett’s Esophagus and Esophageal Adenocarcinoma?

“…12 A novel review on postoperative gastric dysfunction by Dr. Carson and Dr. O’Grady is an excellent contribution to the literature, along with Dr. Till and Dr. Okusanya’s review of the epidemiology and trends in surgical paraesophageal hernias. 13,14 Dr. Iyer and Kunkel describe the impact of an inlet patch on patients with advanced pulmonary disease and after transplant and the role of ablation. 15 Dr. Ma and Dr. Yadlapati share their fantastic study showing that patients with elevated salivary pepsin have increased oral microbiome diversity, which may have implications for GERD.…”