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Malnutrition after gastric surgery
Digestive Diseases and Scnces, Vol. 30, No. 3 (March 1985), pp. 193-199
Malnutrition After Gastric Surgery
Association with Exaggerated Distal Intestinal Hormone
Release
DONALD P. KOTLER, DEBORAH SHERMAN, STEPHEN R. BLOOM, and PETER R. HOLT
This study was designed to investigate the mechanism of excessive weight loss following
gastric surgery. Twelve weight-stable and six weight-losing postoperative subjects were
studied. The weight-losing subjects had lesser body mass based upon anthropometric
measurements. All weight-losing subjects and six weight-stable subjects excreted excess
breath hydrogen after a standard meal. The quantities of hydrogen excreted by the
weight-losing subjects and weight-stable subjects with positive tests were not different,
implying similar degrees o f carbohydrate malabsorption. Peak breath hydrogen concen-
tration occurred earlier in weight-losing subjects than in weight-stable subjects (2 vs 5 hr),
indicating more rapid oral-cecal transit of the test meal in weight-losing subjects.
Analyses of postprandial blood samples for eight different gastrointestinal hormones
demonstrated exaggerated postprandial elevations in the concentrations o f enterogluca-
gon and neurotensin, The results of these studies demonstrate close correlations between
excessive weight loss after gastric surgery, rapid gastrointestinal transit as measured by
excess breath hydrogen excretion, and increased release o f hormones from the distal
intestine. We conclude that these hormones are secreted in excess due to the rapid
gastrointestinal transit and that rapid gastrointestinal transit may play a role in excessive
weight loss after gastric surgery.
Modest weight loss of less than 10% of preoperative
weight is common after gastric surgery, but m o s t
patients remain well nourished. Some patients,
however, lose excessive amounts of weight and
become overtly malnourished. The nutritional man-
agement of these patients is difficult an
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