BACTERIAL OVERGROWTH, INTESTINAL TRANSIT, AND NUTRITION AFTER TOTAL GASTRECTOMY - COMPARISON OF A JEJUNAL POUCH WITH ROUX-EN-Y RECONSTRUCTION IN A PROSPECTIVE RANDOM STUDY

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.