BACTERIAL OVERGROWTH, INTESTINAL TRANSIT, AND NUTRITION AFTER TOTAL GASTRECTOMY - COMPARISON OF A JEJUNAL POUCH WITH ROUX-EN-Y RECONSTRUCTION IN A PROSPECTIVE RANDOM STUDY
Mk. Iivonen et al., BACTERIAL OVERGROWTH, INTESTINAL TRANSIT, AND NUTRITION AFTER TOTAL GASTRECTOMY - COMPARISON OF A JEJUNAL POUCH WITH ROUX-EN-Y RECONSTRUCTION IN A PROSPECTIVE RANDOM STUDY, Scandinavian journal of gastroenterology, 33(1), 1998, pp. 63-70
Background: Jejunal pouches after total gastrectomy have been introduc
ed to diminish postgastrectomy symptoms and improve nutrition. However
, the effect of a pouch on the intestinal bacteriology and transit is
controversial. Methods: Bacterial overgrowth was measured with the glu
cose breath test and the mouth-to-caecum transit time (MCTT) by means
of the lactulose breath test after total gastrectomy and Roux-en-Y rec
onstruction in 24 patients with a pouch (Pouch group) and in 22 patien
ts without a pouch (Roux-en-Y group). Postoperative symptoms were eval
uated with a standard questionnaire, and nutrition was measured by blo
od chemistry and weight loss. Results: MCTT was 110 +/- 44 min in the
Roux-en-Y group and 117 +/- 44 min in the Pouch group (NS). Eighty-six
per cent of the patients in the Roux-en-Y group and 91% of the patien
ts in the Pouch group had bacterial overgrowth (NS). Transit time was
shorter in patients with severe dumping than patients without dumping
(60 +/- 28 min versus 115 +/- 41 min; P = 0.04). Maximal hydrogen conc
entration in the glucose breath test correlated negatively with serum
albumin and iron concentrations and with postoperative weight loss, an
d positively with serum alkaline phosphatase activity. Conclusions: Ba
cterial overgrowth is common in the upper intestine after total gastre
ctomy. Pouch reconstruction does not delay the transit of liquids. Bac
terial overgrowth may be one of the main aetiologic factors in postgas
trectomy malnutrition.