Postgastrectomy polyneuropathy with thiamine deficiency

Objective-Polyneuropathy has been reported after gastrectomy performed to t reat various lesions. Although thiamine deficiency is a possible cause of t his neuropathy, the pathogenesis still remains to be clarified. Seventeen p atients with peripheral neuropathy with thiamine deficiency after gastrecto my are described. Methods-Seventeen patients with polyneuropathy after gastrectomy accompanie d by thiamine deficiency were selected. Patients were restricted to those w ith total or subtotal gastric resection to treat ulcer or neoplasm. Patient s who had undergone operations to treat morbid obesity were excluded. Results-Intervals between the operation and onset of neuropathy varied from 2 months to 39 years. Most patients did not seem malnourished. Serum conce ntrations of B vitamins other than thiamine were nearly normal. Symmetric m otorsensory polyneuropathy, predominantly involving the lower limbs, had pr ogressed over intervals varying from 3 days to 8 years. Relative degrees of motor and sensory impairment also varied extensively. Some cases that prog ressed rapidly mimicked Guillain-Barre syndrome. Electrophysiological and p athological findings were those of axonal neuropathy. Substantial functiona l recovery from polyneuropathy was seen in most patients by 3 to 6 months a fter initiating thiamine supplementation. Motor recovery was better than se nsory recovery. Conclusions-Various symptoms were seen in patients with postgastrectomy neu ropathy. Thiamine deficiency should be considered in the differential diagn osis of motor-sensory polyneuropathy after gastrectomy.