Foregut Exclusion Enhances Incretin and Insulin Secretion After Roux-en-Y Gastric Bypass in Adults With Type 2 Diabetes

INTRODUCTION

Patients with type 2 diabetes experience resolution of hyperglycemia within days after Roux-en-Y gastric bypass (RYGB) surgery. This is attributed, in part, to enhanced secretion of hindgut factors following exclusion of the gastric remnant and proximal intestine during surgery. However, evidence of the mechanisms of remission remain limited due to the challenges of metabolic evaluation during the early postoperative period. The purpose of this investigation was to determine the role of foregut exclusion in the resolution of type 2 diabetes after RYGB.

METHODS

Patients with type 2 diabetes (n = 15) undergoing RYGB had a gastrostomy tube (G-tube) placed in their gastric remnant at time of surgery. Patients were randomized to receive a mixed meal tolerance test via oral or G-tube feeding immediately prior to and 2 weeks after surgery in a repeated measures crossover design. Plasma glucose, insulin, C-peptide, incretin responses, and indices of meal-stimulated insulin secretion and sensitivity were determined.

RESULTS

Body weight, fat mass, fasting glucose and insulin, and circulating lipids were significantly decreased 2 weeks after surgery. The glycemic response to feeding was reduced as a function of total area under the curve but not after adjustment for the reduction in fasting glucose. Oral feeding significantly enhanced insulin and incretin secretion after RYGB, which was entirely ablated by G-tube feeding.

CONCLUSION

Foregut exclusion accounts for the rise in incretin and insulin secretion but may not fully explain the early improvements in glucose metabolism after RYGB surgery.

Preoperative Blood Glucose Level Predicts Postsurgical Gastroparesis Syndrome after Subtotal Gastrectomy: Development of an Individualized Usable Nomogram

BACKGROUND

Postsurgical gastroparesis syndrome (PGS) after subtotal gastrectomy imposes significant social and economic burdens. We aimed to investigate the relationship between preoperative blood glucose level and PGS and develop a nomogram for individualized prediction. Patients and Methods. We retrospectively analyzed 633 patients with gastric cancer who underwent subtotal gastrectomy. Preoperative blood glucose levels were evaluated via receiver operating characteristic (ROC) curve analysis. Chi-squared tests and multivariable logistic regression analyses were used to develop a predictive model for PGS, presented as a nomogram, which was assessed for its clinical usefulness.

RESULTS

Thirty-eight of 633 patients were diagnosed with PGS. Based on the ROC curve analysis, the preoperative blood glucose cutoff value for PGS was 6.25 mmol/L. The predictors of PGS included preoperative hyperglycemia (odds ratio (OR) 2.3, P = 0.03), body mass index (BMI; OR 0.21, P = 0.14 for BMI < 18.5 and OR 3.0, P = 0.004 for BMI > 24), and the anastomotic method (OR 7.3, P = 0.001 for Billroth II and OR 5.9, P = 0.15 for Roux-en-Y). The predictive model showed good discrimination ability, with a C-index of 0.710, and was clinically useful.

CONCLUSIONS

Preoperative hyperglycemia effectively predicts PGS. We present a nomogram incorporating the preoperative blood glucose level, BMI, anastomotic method, and tumor size, for individualized prediction of PGS.

[Prevention, diagnosis and treatment of perioperative complications of bariatric and metabolic surgery]

Surgical operation in treating obesity and type 2 diabetes is popularizing rapidly in China. Correct prevention and recognition of perioperation-related operative complications is the premise of ensuring surgical safety. Familiar complications of the operation include deep venous thrombosis, pulmonary artery embolism, anastomotic bleeding, anastomotic fistula and marginal ulcer. The prevention of deep venous thrombosis is better than treatment. The concrete measures contain physical prophylaxis (graduated compression stocking and intermittent pneumatic compression leg sleeves) and drug prophylaxis (unfractionated heparin and low molecular heparin), and the treatment is mainly thrombolysis or operative thrombectomy. The treatment of pulmonary artery embolism includes remittance of pulmonary arterial hypertension, anticoagulation, thrombolysis, operative thrombectomy, interventional therapy and extracorporeal membrane oxygenation (ECMO). Hemorrhage is a rarely occurred but relatively serious complication after bariatric surgery. The primary cause of anastomotic bleeding after laparoscopic gastric bypass is incomplete hemostasis or weak laparoscopic repair. The common bleeding site in laparoscopic sleeve gastrectomy is gastric stump and close to partes pylorica, and the bleeding may be induced by malformation and weak repair technique. Patients with hemodynamic instability caused by active bleeding or excessive bleeding should timely received surgical treatment. Anastomotic fistula in gastric bypass can be divided into gastrointestinal anastomotic fistula and jejunum-jejunum anastomotic fistula. The treatment of postoperative anastomotic fistula should vary with each individual, and conservative treatment or operative treatment should be adopted. Anastomotic stenosis is mainly related to the operative techniques. Stenosis after sleeve gastrectomy often occurs in gastric angle, and the treatment methods include balloon dilatation and stent implantation, and surgical treatment should be performed when necessary. Marginal ulcer after gastric bypass is a kind of peptic ulcer occurring close to small intestine mucosa in the junction point of stomach and jejunum. Ulcer will also occur in the vestige stomach after laparoscopic sleeve gastrectomy, and the occurrence site locates mostly in the gastric antrum incisal margin. Preoperative anti-HP (helicobacter pylorus) therapy and postoperative continuous administration of proton pump inhibitor (PPI) for six months is the main means to prevent and treat marginal ulcer. For patients on whom conservative treatment is invalid, endoscopic repair or surgical repair should be considered. Different surgical procedures will generate different related operative complications. Fully understanding and effectively dealing with the complications of various surgical procedures through multidisciplinary cooperation is a guarantee for successful operation.

[Efficacy of the use of remnant stomach in esophagoplasty]

In the period from 2001 till 2010 there were 117 extirpations of the oesophagus with single-stage plasty of the stomach in 94 patients and plasty of the large intestine--in 23 cases. Gastric resections were performed earlier in 50 (42.7%) patients, though gastrectomy took place in 39 (78%) patients. The accumulated experience allowed making an assessment of immediate and long-term results of esophagoplasty to patients, who had earlier the gastric resection. The incompetence of oesophagogastric anastomosis was noted in 2 times more frequent and the formation of stenosis of given anastomosis in 3 times more often. I order to improve the results of esophagoplasty, the method of serousmyotomy was applied in the cases of remnant stomach.

Assessment of gastric emptying function after gastrectomy using a real-time ¹³C breath test

BACKGROUND/AIMS

Effectiveness of gastric emptying after pylorus-preserving gastrectomy (PPG) remains unclear and a method for continuous assessment is needed. We assessed post-PPG gastric emptying with a continuous real-time ¹³C breath test (BreathID system, Oridion, Israel).

METHODOLOGY

Gastric emptying function was assessed by ¹³C breath test in 12 post-PPG patients and 9 post-distal gastrectomy (DG) patients. Continuous ¹³C-acetic acid breath test was performed using the BreathID system. Endoscopic study was also completed.

RESULTS

Diarrhea was significantly less common in PPG than DG patients (p=0.021). No other questionnaire items and endoscopic findings showed a significant difference. In the ¹³C-acetic acid breath test, the gastric emptying coefficient (GEC) was significantly greater in PPG than DG patients (p=0.025). No other test parameters showed a significant difference.

CONCLUSIONS

Emptying function in the remnant stomach was assessed successfully by the continuous ¹³C-acetic acid breath test. A greater GEC suggested better gastric emptying in PPG patients.

Physiological evaluation of residual stomach motility after local resection in conscious dogs

PURPOSE

To investigate the phenomenon of remnant gastric motility and emptying after local resection.

METHODS

Fifteen dogs were divided into three groups: a control (CONT) group, a group that underwent local resection of the greater (GREAT) curvature, and a group that underwent resection of the lesser (LESS) curvature. We conducted a strain gauge force transducer study, a [(13)C]octanoic acid breath test ((13)C-OBT), and a mosapride citrate effect test. Based on these results, we worked out the receptive relaxation (RR), motility index (MI), and postprandial period (PP) in the postprandial state, and the frequency, duration, and MI of phase III in the fasted state. The half emptying time (T (1/2)) of (13)C-OBT was also calculated. The MI was compared according to the mosapride effect test results.

RESULTS

Postprandial RR, antro-pyloro-duodenal coordination, and fasting contractions were maintained in all three groups. Receptive relaxation was significantly shorter in the LESS group than in the other groups. Motility index was significantly lower in both treatment groups than in the CONT group. The PP was significantly longer in the GREAT group than in the other two groups. The (13)CO(2) excretion curves did not differ significantly among the groups. The duration of phase III was remarkably less in the treatment groups than in the CONT group, and MI was significantly lower in the LESS group than in the other groups in the fasted state. The MI increased remarkably after mosapride administration in the CONT group, showing no differences in other objective groups.

CONCLUSION

Gastric function was maintained after gastric local resection, although its motility decreased.

[The function of gastric stump and duodenum after proximal gastric resection in patients with esophageal and gastric varicose veins dilatation]

The authors had developed the technique of proximal gastric resection with cardiac orifice plasty. 21 patients with esophageal and varicose veins dilatation were operated on using the technique. Follow-up period came from 2 to 23 years. Results of the operation allow proximal gastric resection with cardiac orifice plasty to be considered the effective way of prevention and treatment of gastric bleedings of portal hypertension aetiology.

[Evaluation of the preserved function of the remnant stomach in pylorus preserving-gastrectomy by gastric emptying scintigraphy]

This study evaluated the preserved function of the remnant stomach by gastric emptying scintigraphy 1 year postoperatively in 49 patients who underwent pylorus-preserving gastrectomy (PPG), and it investigated whether this examination method is a useful tool for evaluation. The residual stomach function was classified as rapid, intermediate, and delayed emptying types according to gastric emptying curves. Then, the relationships were examined between the gastric emptying types and postprandial symptoms, food intake status, body weight changes, and endoscopic findings. Seventy-three percent of the PPG patients were classified as belonging to the intermediate emptying type, and the remainder (27%) to the delayed type. The frequencies of complaints such as epigastric fullness, nausea, and vomiting were high in the delayed emptying-type patients. The intermediate emptying-type patients consumed larger amounts of food and gained more weight than the delayed emptying-type patients. In conclusion, gastric function was evaluated by gastric emptying scintigraphy in PPG patients. This method might be useful not only for evaluating the motor function of the remnant stomach, but also for predicting postoperative status. Although PPG is a function-preserving operation, it should be considered that a quarter of the patients showed delayed emptying type which related to poor quality of life.

Assessment of the preserved function of the remnant stomach in pylorus-preserving gastrectomy by gastric emptying scintigraphy

BACKGROUND

This study evaluated the preserved function of the remnant stomach by gastric emptying scintigraphy in patients who underwent pylorus-preserving gastrectomy (PPG), and it investigated whether this examination method is a useful tool for evaluation.

MATERIALS AND METHODS

The residual stomach function was evaluated by gastric emptying scintigraphy in 45 patients with early gastric cancer who had undergone PPG. Function was classified as rapid, intermediate, and delayed emptying types according to gastric emptying curves. Then, the relationships were examined between the gastric emptying types and postprandial symptoms, food intake status, body weight changes, and endoscopic findings.

RESULTS

Seventy-three percent of the PPG patients were classified as belonging to the intermediate emptying type, and the remainder to the delayed emptying type. The frequencies of complaints such as epigastric fullness, nausea, and vomiting were high in the delayed emptying-type patients. The intermediate emptying-type patients consumed larger amounts of food and gained more weight than the delayed emptying-type patients. It was difficult to estimate gastric emptying function from endoscopic findings.

CONCLUSIONS

Gastric function was evaluated by gastric emptying scintigraphy in PPG patients. This method might be useful not only for evaluating the motor function of the remnant stomach, but also for predicting postoperative status.

Evaluation of residual stomach motility after proximal gastrectomy for gastric cancer by electrogastrography

The relationship between the motility and the size of the residual stomach after proximal gastrectomy was evaluated using electrogastrography (EGG). Based on fast Fourier transformation, recorded slow waves could be analyzed to obtain the following parameters: dominant frequency (DF), percentage normal frequency (% 3 cycles per minute [cpm]), and power ratio (PR). EGG parameters, the length of the greater curvature of the residual stomach (LGC), were recorded in 18 gastrectomized patients. Compared to 12 healthy controls, the gastrectomized patients had abdominal EGG parameters including lower %3cpm (43 +/- 21% vs 83 +/- 7%; P < 0.05), DF (2.2 +/- 0.4 vs 3.0 +/- 0.2 cpm; P < 0.05), and PR (1.5 +/- 0.8 vs 2.5+/- 0.8; P < 0.05). In relation to LGC and parameters, there was no difference between the patients whose LGC was > 20 cm and controls in PR (2.3+/- 0.9 vs 2.5+/- 0.8; n.s.). In conclusion, the motility of the residual stomach would be equal to that of the nonresected stomach as if the volume of the residual stomach was more than half.

The role of gastric distention in differentiating recurrent tumor from physiologic uptake in the remnant stomach on 18F-FDG PET

Physiologic (18)F-FDG uptake in the stomach can often cause false-positive results and lowers the usefulness of (18)F-FDG PET in evaluating the remnant stomach. We assessed the role of gastric distension to see whether it is beneficial for the differentiation of recurrent tumors from physiologic (18)F-FDG uptake in the remnant stomach.

METHODS

Thirty patients (22 men and 8 women; age range, 27-80 y; mean age, 58.3 y) with a history of subtotal gastrectomy for gastric cancer underwent (18)F-FDG PET for various clinical indications. After whole-body imaging, the patients were asked to drink water, and then spot imaging of the stomach was performed. (18)F-FDG uptake in the remnant stomach was considered positive for malignancy if it was persistently increased, whether focal or diffuse, after water ingestion. We used 2 standardized uptake value (SUV) criteria to differentiate benign from malignant uptake. First, a lesion was considered benign if its SUV was less than 2 on whole-body imaging. Second, for a lesion with an SUV of 2 or above, it was classified as benign if SUV decreased by more than 10% after water ingestion.

RESULTS

Visual analysis of whole-body images produced 9 true-negative, 4 false-positive, 16 true-positive, and 1 false-negative results. Use of additional spot images produced 12 true-negative, 1 false-positive, 15 true-positive, and 2 false-negative results. When an SUV cutoff of 2 was applied for malignancy before water ingestion, all 17 patients with local recurrence were correctly identified, but 11 of the 13 patients without local recurrence were falsely considered to have a recurrent tumor in the remnant stomach. To reduce the false-positive results, we used the second SUV criterion after water ingestion. Use of that criterion produced 4 false-negative results although it correctly identified the 11 false-positive results as true negative.

CONCLUSION

Gastric distension by having patients drink a glass of water seems to be a simple, cost-effective way of improving the diagnostic accuracy of (18)F-FDG PET in patients with suspected recurrence in the remnant stomach. Visual analysis with special attention to the configuration of (18)F-FDG activity after water ingestion seems to be more useful than the change in SUV in evaluating the remnant stomach.

Inhibitory remnant stomach motility by duodenal distention after B-I gastrectomy

BACKGROUND/AIMS

Although control of gastric motility is a highly regulated process, B-I gastrectomy causes accelerated gastric emptying. We found few reports so far concerned with the mechanical effect of balloon distention of the duodenum on the remnant stomach in B-I dogs.

METHODOLOGY

Four weeks after conventional distal gastrectomy with B-I reconstruction procedure, a balloon was inserted into the duodenum, and strain gauge force transducers (SGTs) were sutured onto the wall of the gastric remnant and duodenal serosa in beagles. After a two-week postoperative recovery period, gastro-duodenal motility was measured with SGTs prior to distention, during distention, and after evacuation of the balloon. The motility index (MI) was calculated every 30 minutes.

RESULTS

Upon duodenal distention with 4 mL of water, motility of gastric remnant was significantly inhibited, however, no reduction in duodenal MI was observed. The response was maintained for as long as duodenal distension continued. Ninety minutes after evacuation of the balloon, MI returned to predistension levels. Increased plasma levels of cholecystokinin (CCK) were observed upon distention of the duodenal balloon.

CONCLUSIONS

Motility of the remnant stomach in B-I dogs was inhibited by duodenal distension. Increased levels of plasma CCK during distention might play a role in this feedback mechanism.

[Impact of isovolumic hemodilution on the local hemodynamics of the resected stomach in patients with ulcer disease]

The influence of isovolumic hemodilution on the local hemodynamics of the resected stomach in patients with a complicated course of duodenal ulcer was studied. In the course of the analysis of parameters of the local blood flow of the intact and resected stomach, the best indices were received in patients with preoperative isovolumic hemodilution. Preoperative isovolumic hemodilution in patients with a complicated course of duodenal ulcer after the stomach resection reduces the risk of early postoperative complications.

[X-ray characteristics of the functional performance of the gastrointestinal tract after radical surgery for gastric cancer]

The paper gives the X-ray characteristics of the functional performance of the gastrointestinal tract in 127 patients after radical operations performed by classical and plastic techniques for gastric cancer.

Gastric carcinogenesis by duodenal reflux through gut regenerative cell lineage

To elucidate the histogenesis of gastric stump cancer, we performed an operation in rats to make all duodenal contents flow back into the glandular stomach. The subjects were 41 rats, and sequential morphological changes of the duodenogastric stoma and the incidence of stump cancers were studied. Serial sections around the stoma were studied with mucin stains such as paradoxical concanavalin A (Con A), galactose oxidase Schiff (GOS), and high-iron diamine-Alcian blue (HID-AB). An immunohistochemical study on cell proliferation with bromodeoxyuridine (BrdU) was also done. At week 30, pyloric gland type cells positive for Con A first appeared at the base of the intestinal crypts and the fundic glands adjacent to the anastomosis. These glands became large with time, resulting in formation of cystically dilated glands. These gland cells were partially stained with GOS, and then they retained a proliferative activity. These changes seemed to resemble "gastritis cystica profunda" in human remnant stomachs. At 50 and 80 weeks, adenocarcinomas were observed in 4 of 10 rats (40.0%) and in 16 of 21 rats (76.2%), respectively. We have noted that the early change of cystic proliferation of mucous glands resembled the so-called "ulcer associated cell lineage (UACL)" described by others, but our characteristic finding was not only pyloric but also foveolar metaplasia. This pyloric-foveolar metaplasia subsequently led to development of glands with intestinal-type goblet cells, which looked like incomplete intestinal metaplasia. This sequence was different from UACL, and very recently, we proposed a concept of "gut regenerative cell lineage (GRCL); from pyloric-foveolar to with goblet cell metaplasia in regeneration," common to all parts of the gut, and the stump cancer appeared to arise from GRCL.

Duodenogastric reflux sustains Helicobacter pylori infection in the gastric stump

BACKGROUND

Duodenogastric reflux (DGR) and Helicobacter pylori infection have been suspected of being contributing agents to the genesis of gastritis and subsequent cancer, but compelling, conclusive data about the exact relationship have been lacking.

METHODS

We investigated the effect of DGR on H. pylori infection in 95 gastrectomized subjects divided into four groups according to type of reconstruction: the jejunal pouch interposition group (JPI, n = 36); the Roux-en-Y group (RY, n = 17); the Billroth I group (B-I, n = 20); and the Billroth II group (B-II, n = 22). The following items were examined for each group: the duration of DGR; the prevalence of H. pylori infection; other bacterial identification and quantity; and the severity of gastritis.

RESULTS

The percent of total time of DGR was lower in the JPI (7%) and RY groups (28%) than in the B-I (59%) and B-II groups (88%) (P < 0.02). The prevalence of H. pylori infection was lower in the JPI (28%) and RY groups (29%) than in the B-I (60%) and B-II groups (73%) (P < 0.02). Inversely, the JPI and the RY groups had a higher quantity of other bacteria than the B-I group (P = 0.02). For all four groups, the stomachs infected with H. pylori were fewer than those tested negative for the organism (P < 0.0001). Inflammation scores were lower in both the JPI and RY groups than in the B-I and B-II groups (P < 0.05, respectively).

CONCLUSIONS

Duodenogastric reflux facilitates the survival of H. pylori in the gastric stump after a distal gastrectomy.

[Bioelectrical activity and evacuation function of the gastric stump in an early period after different means of gastric resection and variations in the formation of anastomoses]

The results of the stomach resection on the occasion of stomach and duodenal ulcer were analyzed. Bioelectric activity of the stomach stump was studied in a comparative aspect, and early recovery of the motor function of the resected stomach after the formation of pyloroimitating gastroduodenal anastomoses was shown. Revealed roentgenologic mechanisms of the evacuator function of the stomach stump let us determine evacuation types for the early postoperative period. The formation of pyloroimitating gastroduodenal anastomoses is functionally advantageous.

[Primary carcinoma of the gastric stump. Physiopathological, diagnostic and therapeutic considerations]

Even though the primary carcinoma of the gastric stump is a tumor that will diminish in frequency in the years to come, it is still a topic of scientific studies. The authors report their experience with four cases of primary carcinoma of the gastric stump treated surgically as compared to 89 cases of carcinoma of the stomach operated in the same period. After some comments on the etiopathogenesis that is at the basis of the neoplastic mutations of the remaining gastric epithelium, clinical, prognostic and pathologic features that differentiate this type of tumor from those which develop in unoperated stomachs are examined and, then, the most frequent therapeutic approaches are illustrated. In conclusion, it is sustained that patients who have undergone partial gastrectomy for benign disease should be closely followed-up from the tenth year after the operation and, in any case, in those who are over fifty years of age.

[Functional improvement of remnant stomach after proximal subtotal gastrectomy for cardiac cancer]

OBJECTIVE

To evaluate the function of the remnant stomach after proximal subtotal gastrectomy for cardiac cancer and to improve the life quality of post-surgical patients.

METHODS

17 patients with cardiac cancer underwent proximal subtotal gastrectomy combined with disconnection of pyloric sphincter (PSG + DPS) by finger pressing. Intraoperative pyloric manometric studies were performed in the 17 patients before and after DPS. Five subjects who underwent laparotomy for non-esophagogastric reasons was taken as controls. Total bile acids (TBA) in gastric juice was tested in the 17 patients at 5th postoperative day, and radionuclide gastric emptying was also studied from the 18th to 20st postoperative day.

RESULTS

Both pyloric resting pressure and pyloric contracting pressure were significantly decreased after DPS (P > 0.01). In comparison with normal subjects, PCP was increased before DPS (P > 0.01) and decreased after the procedure (P < 0.05). However, PRP did not show significant differences before (P > 0.05) and after (P > 0.05) DPS. There were no significant differences regarding TBA content in gastric juice in PSG + DPS group, PSG group, and normal subjects (P > 0.05). The time required for the stomach to empty half of its radioactive contents (T1/2) was longer in the patients having PSG only than those undergoing PSG + DPS (P < 0.01) and normal controls (P < 0.05). However, there were no significant differences regarding T1/2 between the patients with PSG + DPS and normal controls (P > 0.05).

CONCLUSIONS

The emptying of remnant stomach after subtotal gastrectomy for cardiac cancer is delayed because of the increase of emptying-resistance and decrease of peristalsis. PSG combined with DPS not only improves gastric emptying, but also prevents duodenogastric reflux. Consequently, postoperative life quality of the patients with cardiac cancer can be effectively improved.

Does the stomach remain silent after neonatal loss of its original pacemaker?: gastric motility in long-term survivors of neonatal gastric rupture

Gastric peristaltic contractions are controlled by an intrinsic electrical pacemaker located in the mid-body along the greater curve. This study was undertaken to investigate gastric motility in long-term survivors of neonatal gastric rupture who were surgically deprived of their original pacemaker. Four patients, 1 boy and 3 girls, aged between 6 and 12 years were studied. Physiological activity of the gastric remnant was assessed in terms of electrical as well as peristaltic functions by means of electrogastrography and video-recorded barium swallow study. Electrical and mechanical pacing activities were classified into normogastria or dysrhythmia (brady- or tachygastria) according to their frequencies. In these patients, ectopic pacemakers were found to be arising just distal to the site of resection along the greater curve. Electrophysiologically, one patient was diagnosed as having normogastria, and other 3 patients were found to have dysrhythmia (2, bradygastria; 1, tachygastria) on the basis of electrogastrographic analyses. In two of three patients studied further by fluoroscopy, electrical activity agreed well with peristaltic activity. In one patient, however, electrical tachygastria was associated with peristaltic bradygastria. In conclusion, an ectopic pacemaker arises in the stomach that does not remain silent after neonatal surgical loss of its own pacemaker. Noninvasive electrogastrography seems useful in assessing electrical potentials generated by the ectopic pacemaker.

N-Nitroso compounds, bacteria, and carcinoembryonic antigen in the gastric stump

Analyses of biochemical and microbiological parameters such as pH, N-nitroso compound (NOC) concentration, carcinoembryonic antigen (CEA) level, and total viable counts (TVCs), and identification of microorganisms were carried out on 65 fasting gastric juice samples obtained at endoscopy from 45 patients previously submitted to partial gastrectomy for benign peptic ulcer disease (23 Billroth I, 22 Billroth II/Reichel-Polya) and 20 normal controls. Biopsy specimens were taken to determine histology, the Helicobacter pylori status, and both tissue CEA immunoreactivity and level. Significantly higher mean pH values, NOC and CEA concentrations, and TVCs were found in partial gastrectomies compared with normal controls. In relation to surgical methods, higher mean pH values, NOC concentrations, TVCs, and anaerobic bacterial counts were observed in the juice of patients with Billroth II compared with Billroth I gastrectomies. Mild CEA immunoreactivity and apical CEA localization were found significantly more often in Billroth II than in Billroth I stumps. Intensive CEA immunoreactivity and cytoplasmatic localization were found significantly more often in Billroth I than in Billroth II stumps. Independent of the type of surgical reconstruction, higher mean NOC levels were recorded in patients with more severe histological changes and H. pylori infection. Higher mean CEA levels in gastric juice and tissue were detected in the gastric stumps with more severe histological changes. All these data suggest that high levels of NOCs in the gastric juice could be a cofactor in gastric stump carcinogenesis and determination of CEA level in gastric juice and tissue could be included as a very useful marker in quantifying this process.

[Motor evacuatory disorders of the digestive tract in the early periods after stomach operations (1. Motor evacuatory disorders of the stomach)]

The method of telemetry was used for studying the motor function of the stomach in 60 patients with ulcer disease before operation and in 48 patients at early terms after truncal vagotomy or resection of the stomach. An analysis of 318 cases of similar operations on the stomach was also made. The states of normo-, hypo- and adynamia were documented. A pronounced inhibition of motility of the stomach and its stump were noted during 14 and more days after vagotomy and resection. Under conditions of hypo- and adynamia the evacuatory function was maintained by the positive gastrointestinal gradient of the basal pressure and the peristaltic "pump" effect of the small intestine. The early light motor evacuatory disorders are always of the functional character and disappear by the 5th day after operation. The evacuatory disorders of the moderate and grave degree were functional in 7 from 9 patients after vagotomy and in 9 from 17 patients after resection of the stomach.

[Patient Helicobacter pylori infectivity after gastric resection]

The article is devoted to investigation of the Helicobacter pylori (HP) infection in 14 patients after resection of the stomach for ulcers of the gastroduodenal zone. Different methods were used for the assessment of the state of the gastric stump and gastroenteric anastomosis in the postoperative period. In most cases different degree of inflammatory alterations of the gastric mucosa were detected. In 2 cases (14.3%) peptic ulcers of the anastomosis developed. Changes to the gastric stump of 11 patients were associated with the HP infection which involved the mucosa of the anastomosed intestine in 8 patients. The data obtained point to possible participation of HP pathogenesis of the alterations detected after the stomach resection. The question of the expediency of a specific antibacterial therapy in the postoperative period and in treatment of certain kinds of postgastroresectional syndromes is raised.