Gastrectomized patients are in a state of chronic protein malnutrition analyses of 23 amino acids

Background/Aims: Malnutrition is one of the major postoperative complicatio ns of radical subtotal or total gastrectomy for gastric cancer. This study was conducted to clarify the nutritional consequences of radical gastrectom y with respect to protein metabolism. Methodology: To evaluate the nutritional status and the abnormalities in pr otein metabolism in such cases, serum concentrations of 23 amino acids were measured by high performance liquid chromatography in 40 patients who had undergone either subtotal (n=20) or total (n=20) gastrectomy more than 6 mo nths prior to this analysis. Results: Serum concentrations of total amino acids and nonessential amino a cids were the same between gastrectomized patients and healthy controls (n= 50). However, concentrations of essential amino acids, essential amino acid /nonessential amino acid and branched-chain amino acid/total amino acid rat ios were significantly lower in patient groups than in normal controls. Eac h essential amino acid was decreased and concentrations of glutamate and ci trulline were increased in both patient groups compared with controls. The major differences between patients with subtotal and total gastrectomies in cluded an increased ornithine and a decreased arginine concentration in pat ients with subtotal gastrectomy. Conclusions: These changes suggest that malabsorption of protein from the i ntestinal tract causes persistent proteolysis in the skeletal muscle for lo ng periods of time after surgery in these patients and that changes in orni thine and citrulline levels may reflect more severe alterations in those wi th total gastrectomy.