Effect of plasma cholecystokinin on the development of reflux esophagitis after B-1 gastrectomy.

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(1)Gastric emptying is a highly regulated process, and plasma CCK plays a major role in its feedback regulation. The gastroduodenal motility and gastric emptying of the two anastomosis-methods after B-I gastrectomy were characterized, while assessing the effect of CCK on the motility of the remnant stomach. Remnant stomachs with side-to-end anastomosis showed superior motility as compared to those with end-to-end anastomosis. Plasma CCK was higher in the end-to-end group, and might explain the difference in motility index between the two groups. (2)B-I gastrectomy causes accelerated gastric emptying. Upon duodenal distention, motility of gastric remnant was significantly inhibited, however, no reduction in duodenal MI was observed. The response was maintained for as long as duodenal distension continued. After evacuation of the balloon, MI returned to pre-distension levels. Increased plasma levels of CCK were observed upon distention of the duodenal balloon. Increased levels of plasma … More CCK during distention might play a role in this feedback mechanism. (3)We compared the clinical outcome after mechanical stapling with that after hand suturing in patients who underwent B-I gastrectomy. A prospective randomized trial showed that the stapling anastomosis method was quicker than the hand-suturing method. Anastomotic complications were similar for the two methods. (4)Endoscopic evaluation of the post operative status was done in the patients reconstructed by the jejunal interposition after total gastrectomy, while comparing those results with the patients reconstructed by the Roux-en-Y technique. Stenosis of anastomosis or reflux esophagitis were found in IP group.Mechanosensory stimulation of the digestive tract influences postprandial release of CCK. Transient lower esophageal sphincter relaxations(TLESRs), which have been shown to be the main mechanism of gastro-esophageal reflux disease, are significantly increased by gastric distention in dogs and humans. Gastric distention is a potent trigger for TLESRs probably causes activation of mechanoreceptors in the subcardiac region of the stomach even after B-I gastrectomy and the release of CCK, which might partly play a role of the reflux esophagitis after B-1 gastrectomy. Less