Abstract
The pattern of gastric emptying after truncal vagotomy and drainage is usually biphasic. An early rapid phase is followed by a characteristically abrupt transition to slow emptying. The mechanisms responsible for this pattern were studied in six dogs with truncal vagotomy and pyloroplasty, fitted with a proximal duodenal cannula. Gastric emptying was measured using gamma camera imaging of a radiolabelled 15% dextrose test meal. Sixty one hour studies were done using five designs. (1) With the cannula closed gastric emptying was initially rapid, followed by stasis (emptying at 15 min - 32% (5.3), 60 min - 34% (4.8); mean (SE)). (2) With the cannula open emptying was very rapid (15 min - 76% (4.2) p less than 0.001, 60 min - 88% (2.6) p less than 0.001 ANOVA). (3) Distal duodenal instillation of isotonic saline, at a rate equivalent to gastric emptying with the cannula closed, did not retard this rapid emptying (15 min - 78% (10.6), 60 min - 90% (5.4)). (4) With duodenal instillation of 15% dextrose, gastric emptying remained faster than in studies without diversion (15 min - 50% (7.0) NS, 60 min - 65% (6.8) p less than 0.01), but was slower than during diversion alone (p less than 0.05). (5) Finally, duodenal instillation of 15% dextrose before administration of the test meal produced slower initial emptying without subsequent stasis (15 min - 24% (4.5), 60 min - 47% (10.6)), although the amounts emptied were not significantly different from those with the cannula closed. These results indicate that after truncal vagotomy and pyloroplasty small bowel resistances play a significant role in controlling gastric emptying. Osmoreceptor responses persist after truncal vagotomy, but sympathetic inhibitory responses to small bowel distension are not involved in the regulatory process.
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Selected References
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- Chaudhuri T. K. Use of 99mTc-DTPA for measuring gastric emptying time. J Nucl Med. 1974 Jun;15(6):391–395. [PubMed] [Google Scholar]
- Clarke R. J., Alexander-Williams J. The effect of preserving antral innervation and of a pyloroplasty on gastric emptying after vagotomy in man. Gut. 1973 Apr;14(4):300–307. doi: 10.1136/gut.14.4.300. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Colmer M. R., Owen G. M., Shields R. Pattern of gastric emptying after vagotomy and pyloroplasty. Br Med J. 1973 May 26;2(5864):448–450. doi: 10.1136/bmj.2.5864.448. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Gough M. J., Humphrey C. S., Giles G. R. Does osmotic control of gastric emptying persist after truncal vagotomy? Br J Surg. 1981 Feb;68(2):77–80. doi: 10.1002/bjs.1800680205. [DOI] [PubMed] [Google Scholar]
- Mei N. Vagal glucoreceptors in the small intestine of the cat. J Physiol. 1978 Sep;282:485–506. doi: 10.1113/jphysiol.1978.sp012477. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Miller J., Kauffman G., Elashoff J., Ohashi H., Carter D., Meyer J. H. Search for resistances controlling canine gastric emptying of liquid meals. Am J Physiol. 1981 Nov;241(5):G403–G415. doi: 10.1152/ajpgi.1981.241.5.G403. [DOI] [PubMed] [Google Scholar]
- Parr N. J., Grime J. S., Baxter J. N., Critchley M., Mackie C. R. Small bowel resistances and the gastroduodenal brake. Gut. 1987 Aug;28(8):950–954. doi: 10.1136/gut.28.8.950. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Parr N. J., Grime S., Brownless S., Critchley M., Baxter J. N., Mackie C. R. Relationship between gastric emptying of liquid and postvagotomy diarrhoea. Br J Surg. 1988 Mar;75(3):279–282. doi: 10.1002/bjs.1800750330. [DOI] [PubMed] [Google Scholar]
- Ralphs D. N., Thomson J. P., Haynes S., Lawson-Smith C., Hobsley M., Le Quesne L. P. The relationship between the rate of gastric emptying and the dumping syndrome. Br J Surg. 1978 Sep;65(9):637–641. doi: 10.1002/bjs.1800650915. [DOI] [PubMed] [Google Scholar]
- Shahidullah M., Kennedy T. L., Parks T. G. The vagus, the duodenal brake, and gastric emptying. Gut. 1975 May;16(5):331–336. doi: 10.1136/gut.16.5.331. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Wilbur B. G., Kelly K. A. Effect of proximal gastric, complete gastric, and truncal vagotomy on canine gastric electric activity, motility, and emptying. Ann Surg. 1973 Sep;178(3):295–303. doi: 10.1097/00000658-197309000-00009. [DOI] [PMC free article] [PubMed] [Google Scholar]