Skip to main content
SpringerLink
Log in

Effect of various prokinetic agents on post Roux-en-Y gastric emptying

Experimental and clinical observations

  • Original Articles
  • Published:
Digestive Diseases and Sciences Aims and scope Submit manuscript

Abstract

The effect of various prokinetic drugs was assessed in animals with Roux-en-Y gastrojejunostomy. The agents tested were (1) bethanechol 2.5 mg subcutaneously at 0 min and 30 min postprandially (pp); (2) metoclopramide 20 mg intravenous bolus at 0 min pp; (3) a combination of 1 and 2; (4) oxytocin 5 mg intramuscularly at 0 min and 240 min pp; (5) motilin at 100 ng/kg/hr; or (6) 300 ng/kg/hr continuous intravenous infusion from 0 to 270 min pp. Only bethanechol administration resulted in significantly less gastric retention (65 ±6% vs 32±5% retention at 5 hr). (P<0.002). The animal results with parenteral bethanechol were confirmed in humans with chronic delayed gastric emptying following Roux-en-Y gastrojejunostomy, with a decrease in gastric retention on radionuclide scan from 78.5±5% to 26±12% at 2 hr pp (P<0.01). Initially all patients responded with symptomatic improvement. However, subsequently 3/6 (50%) of patients required total or near total gastrectomy for recurrent symptoms of gastric stasis. Nevertheless, 2/6 (33%) of patients have no further evidence of gastric stasis, and a trial of bethanechol is recommended prior to considering further gastrectomy in patients with the Roux-stasis syndrome.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Boren CH, Way LW: Alkaline reflux gastritis: A reevaluation. Am J Surg 140:40–46, 1980

    PubMed  Google Scholar 

  2. Herrington JL Jr, Scott HW Jr, Sawyers JL: Experience with vagotomy-antrectomy and Roux-en-Y gastrojejunostomy in surgical treatment of duodenal, gastric and stomal ulcers. Ann Surg 199:590–597, 1984

    PubMed  Google Scholar 

  3. Hocking MP, Vogel SB, Falasca CA, Woodward ER: Delayed gastric emptying of liquids and solids following Rouxen-Y biliary diversion. Ann Surg 194:494–501, 1981

    PubMed  Google Scholar 

  4. Huschen C, Chiodine S, Torri F: (Letter) Ann Surg 205:755–756, 1987

    PubMed  Google Scholar 

  5. Mathias JR, Fernandez A, Sninsky CA, Clench MH, Davis RH: Nausea, vomiting and abdominal pain after Roux-en-Y anastomosis: Motility of the jejunal limb. Gastroenterology 88:101–107, 1985

    PubMed  Google Scholar 

  6. Miranda R, Steffes B, O'Leary JP, Woodward ER: Surgical treatment of the postgastrectomy dumping syndrome. Am J Surg 139:40–43, 1980

    PubMed  Google Scholar 

  7. Ritchie WP Jr: Alkaline reflux gastritis: An objective assessment of its diagnosis and treatment. Ann Surg 192:288–298, 1980

    PubMed  Google Scholar 

  8. Ritchie WP Jr: Alkaline reflux gastritis: Late results of a controlled trial of diagnosis and treatment. Ann Surg 203: 537–544, 1986

    PubMed  Google Scholar 

  9. Pellegrini CA, Patti MG, Lewis M, Way LW: Alkaline reflux gastritis and the effect of biliary diversion on gastric emptying of solid food. Am J Surg 150:166–171, 1985

    PubMed  Google Scholar 

  10. Bushkin FL, Woodward ER: Delayed gastric emptying.In Postgastrectomy Syndromes. FL Bushkin, ER Woodward (eds). Philadelphia, WB Saunders, 1976, pp 72–82

    Google Scholar 

  11. Cohen AM, Ottinger LW: Delayed gastric emptying following gastrectomy. Ann Surg 184:689–696, 1976

    PubMed  Google Scholar 

  12. Vogel, SB: Roux-Y biliary diversion for alkaline gastritis: A cure or a new disease?In Gastrointestinal Surgery. JS Narjarian, JP Delaney (eds). Chicago, Year Book Medical Publishers, 1984, pp 221–225

    Google Scholar 

  13. Sawchuck A, Canal D, Grosfeld JL, Slaughter M, Gardner G, O'Connor T, Behrman: Electrical pacing of the Roux limb resolves delayed gastric emptying. J Surg Res 42:635–641, 1987

    PubMed  Google Scholar 

  14. Vogel SB, Hocking MP, Woodward ER: Radionuclide evaluation of gastric emptying in patients undergoing Roux-Y biliary diversion for alkaline reflux gastritis and postgastrectomy dumping. Surg Forum 34:173–175, 1983

    Google Scholar 

  15. Davidson ED, Hersh T: Bile reflux gastritis contribution of inadequate gastric emptying. Am J Surg 130:514–518, 1975

    PubMed  Google Scholar 

  16. Vogel SB, Hocking MP, Woodward ER: Clinical and radionuclide evaluation of Roux-Y diversion for postgastrectomy dumping. Am J Surg 155:57–62, 1987

    Google Scholar 

  17. Martin JL, Beck WJ, McDonald AP, Carlson GM, Mathias JR:99mTc-labeled solid phase meal: A quantitative clinical measurement of human gastric emptying. J Clin Gastroenterol 5:315–519, 1983

    PubMed  Google Scholar 

  18. Vogel SB, Vair DB, Woodward ER: Alterations in gastrointestinal emptying of 99m-technetium labeled solids following sequential antrectomy, truncal vagotomy and Roux-Y gastroenterostomy. Ann Surg 198:506–515, 1983

    PubMed  Google Scholar 

  19. Ehrlein HJ, Buhner S, Thoma G, Schemann M, Keinke O, Tsiamitas C, Schumpelick V: Gastric emptying after Roux-Y and Billroth I gastrectomy depends on viscosity of meal and contractile patterns of small intestine in dogs. Dig Dis Sci 32:529–537, 1987

    PubMed  Google Scholar 

  20. Pinder RM, Brogden RN, Sawyer PR, Speight TM, Avery GS: Metoclopramide: A review of its pharmacological properties and clinical use. Drugs 12:81–131, 1976

    PubMed  Google Scholar 

  21. Schulze-Delrieu K: Metoclopramide. N Engl J Med 305:28–33, 1981

    PubMed  Google Scholar 

  22. Hancock BD, Bowen-Jones E, Dixon R, Dymoch IW, Cowley DJ: The effect of metoclopramide on gastric emptying of solid meals. Gut 15:462–467

  23. McClelland RN, Horton JW: Relief of acute, persistent postvagotomy atony by metoclopramide. Ann Surg 188:439–447, 1978

    PubMed  Google Scholar 

  24. Metzger WH, Cano R, Sturdevant RAL: Effect of metoclopramide in chronic gastric retention after gastric surgery. Gastroenterology 71:30–32, 1976

    PubMed  Google Scholar 

  25. Perkel MS, Moore C, Hersh T, Davidson ED: Metoclopramide therapy in patients with delayed gastric emptying, a randomized double-blind study. Dig Dis Sci 24:662–666, 1979

    PubMed  Google Scholar 

  26. Stadaas JO, Aune S: Clinical trial of metoclopramide on postvagotomy gastric stasis. Arch Surg 104:684–686, 1972

    PubMed  Google Scholar 

  27. Wright RA, MacGregor IL: Effect of metoclopramide on gastric stasis after reversed jejunal loop for postvagotomy diarrhea. Am J Gastroenterol 72:441–443, 1979

    PubMed  Google Scholar 

  28. Kennedy T, Kelly MJ: Metoclopramide in the vagotomized stomach, Part I. in man; Part II. in dog. Postgrad Med J 49(Suppl 4):81–87, 1973

    Google Scholar 

  29. Sheiner HJ, Catchpole BN: Drug therapy for postvagotomy gastric stasis. Br J Surg 63:608–611, 1976

    PubMed  Google Scholar 

  30. Davidson ED, Hersh T, Haun C, Brooks WS: Use of metoclopramide in patients with delayed gastric emptying following gastric surgery. Am Surg 43:40–44, 1977

    PubMed  Google Scholar 

  31. Hashmonai M, Torem S, Argov S, Barzilai A, Schramek A: Prolonged postvagotomy gastric atony treated by oxytocin. Br J Surg 66:550–551, 1979

    PubMed  Google Scholar 

  32. McIntosh CHS, Brown JH: Motilin: Isolation, structure, and basic function.In Gastrointestinal Hormones. GBJ Glass (ed). New York, Raven Press, 1980, pp 223–244

    Google Scholar 

  33. Bloom JR, Christofides ND, Modlin I, Fitzpatrick ML: Effect of motilin on gastric emptying of solid meals in man. Gastroenterology 74:1010, 1978 (abstract)

    Google Scholar 

  34. Debas HT, Yamagishi T, Dryburgh JR: Motilin enhances gastric emptying of liquids in dogs. Gastroenterology 73:777–780, 1977

    PubMed  Google Scholar 

  35. Machella TE, Hodges HH, Lorber SH: The restoration of gastric motility by urethane of B-methylcholine after section of the vagus nerves for peptic ulcer. Gastroenterology 8:36–51, 1947

    Google Scholar 

  36. Gillman, Goodman, Gillman:In The Pharmacologic Basis of Therapeutics, 7th ed. AG Gillman, LS Goodman, TW Rall, F Murad (eds). New York, Macmillan, 1985, pp 100–109

    Google Scholar 

  37. Feldman M, Schilter L: Effect of bethanechol (urecholine) on gastric acid and non-parietal secretions in normal subjects and duodenal ulcer patients: Comparison with atropine, pentogastrin, and histamine. Gastroenterology 83:262–266, 1982

    PubMed  Google Scholar 

  38. Feldman M, Walsh JH: Effect of bethanechol on gastric acid secretion and serum gastrin concentration after proximal gastric vagotomy. Ann Surg 196:14–17, 1982

    PubMed  Google Scholar 

  39. Vasconez LO, Adams JT, Woodward ER: Treatment of reluctant post vagotomy stoma with bethanechol. Arch Surg 100:693–694, 1970

    PubMed  Google Scholar 

  40. Malagelada JR, Wynne WDW, Mazzotta LJ, Go VLW: Gastric motor abnormalities in diabetic and post vagotomy gastroparesis: Effect of metoclopramide and bethanechol. Gastroenterology 78:286–293, 1980

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgery, University of Florida College of Medicine, HSC, Box J-286, 32610, Gainesville, Florida

    Michael P. Hocking MD, Mathew E. Brunson MD & Stephen B. Vogel MD

Authors
  1. Michael P. Hocking MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mathew E. Brunson MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Stephen B. Vogel MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Hocking, M.P., Brunson, M.E. & Vogel, S.B. Effect of various prokinetic agents on post Roux-en-Y gastric emptying. Digest Dis Sci 33, 1282–1287 (1988). https://doi.org/10.1007/BF01536681

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF01536681

Key words

Search

Navigation