ORAL ERYTHROMYCIN IMPROVES GASTROINTESTINAL MOTILITY AND TRANSIT AFTER SUBTOTAL BUT NOT TOTAL GASTRECTOMY FOR CANCER

Background Erythromycin has been shown to be a powerful prokinetic of the gastrointestinal tract. Little is known about its value to improve motility and transit in gastrectomized patients. Methods Thirteen dis ease-free patients subjected to subtotal gastrectomy and 11 subjected to total gastrectomy for gastric cancer entered the study. Gastrointes tinal transit of a standard Tc-99m-labelled meal and fasting motility were studied before and after oral erythromycin. Results In patients w ho had subtotal gastrectomy mean(s.d.) gastric half-emptying time was 42(14) min before and 26(11) min after erythromycin (P = 0.011). Befor e erythromycin prolonged rhythmical contractions (3 per min) were reco rded in eight patients, sporadic non-organized contractions in two and prolonged bursts of waves in one. After erythromycin, clustered waves resembling a migrating motor complex (MMC) appeared in eight patients , while rhythmic motor activity was unchanged in three. In patients wh o had total gastrectomy jejunal half-emptying time was 39(18) min befo re and 45(12) min after erythromycin. In eight patients, frequent MMCs were recorded, peristaltic in four, synchronous in one, antiperistalt ic in two, with clusters of nonpropagated waves in one. After erythrom ycin, longer peristaltic MMCs were recorded in three, antiperistaltic MMCs persisted in two, synchronous in one and clusters of non-propagat ed waves in two. Conclusion Oral erythromycin improves gastrointestina l transit and motility after subtotal gastrectomy. The findings after total gastrectomy are controversial.