Studies of the Mechanism of Postgastrectomy Steatorrhea
Authors: C. WILMER WIRTS
Journal: Annals of Internal Medicine (1963)

Article1 January 1963Studies of the Mechanism of Postgastrectomy SteatorrheaC. WILMER WIRTS, M.D., F.A.C.P., FRANZ GOLDSTEIN, M.D.C. WILMER WIRTS, M.D., F.A.C.P., FRANZ GOLDSTEIN, M.D.Author, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-58-1-25 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptThe incidence of weight loss or failure to gain weight after resectional surgery for peptic ulcer disease has been shown to vary from approximately 40 to 70 per cent in most series (1-4). Ellison (5) found that, among 290 postgastrectomy patients he followed personally, 2 of every 3 were below their ideal weights and one of 3 was more than 10 per cent below the ideal minimal weight. Seven of 100 patients who had undergone an 85 per cent Hoffmeister resection were so debilitated after their operation that they were unable to return to their normal occupation.Fat excretion studies...References1. IVYGROSSMANBACHRACH ACMIWH: Peptic Ulcer, The Blakiston Company, Philadelphia, 1950. Google Scholar2. SHINGELTONISLEYFLOYDSANDERSBAYLINPOSTLETHWAITRUFFIN WWJKRDAPGJRWJM: Studies on postgastrectomy steatorrhea using radioactive triolein and oleic acid. Surgery 42: 12, 1957. MedlineGoogle Scholar3. ZOLLINGERELLISON RMEH: Nutrition after gastric operations. JAMA 154: 811, 1954. CrossrefMedlineGoogle Scholar4. RANDALL HT: Alterations in gastrointestinal tract function following surgery. Nutrition and the dumping syndrome after gastrectomy. Surg. Clin. N. Amer. April, p. 585, 1958. CrossrefMedlineGoogle Scholar5. ELLISON EH: Malabsorption syndromes in the postgastrectomy patient. Amer. J. Dig. Dis. (n.s.) 2: 669, 1957. CrossrefMedlineGoogle Scholar6. LAWRENCEVANAMEEPETERSONMCNEERLEVINRANDALL WPASGSHT: Alterations in fat and nitrogen metabolism after total and subtotal gastrectomy. Surg. Gynec. Obstet. 110: 601, 1960. Google Scholar7. EVERSON TC: Nutrition following total gastrectomy with particular reference to fat and protein assimilation. Collective review. Surg. Gynec. Obstet. 95: 209, 1952. Google Scholar8. WOLLAEGERCOMFORTWEIROSTERBERG EEMWJFAE: The total solids, fat and nitrogen in the feces. II. A study of persons who had undergone partial gastrectomy with anastomosis of the entire cut end of the stomach and the jejunum (Polya anastomosis). Gastroenterology 6: 93, 1946. MedlineGoogle Scholar9. LUNDH G: Intestinal digestion and absorption after gastrectomy. Acta Chir. Scand. supp. 231, 1958. Google Scholar10. BUTLER TJ: A study of the pancreatic response to food after gastrectomy in man. Gut 1: 55, 1960. CrossrefMedlineGoogle Scholar11. ANNISHALLENBECK DGA: Effects of partial gastrectomy on canine external pancreatic secretion. Surgery 31: 517, 1952. MedlineGoogle Scholar12. PFEFFERSTEPHENSONHINTON RBHEJW: The effect of thoracolumbar sympathectomy and vagus resection on pancreatic function in man. Ann. Surg. 136: 585, 1952. MedlineGoogle Scholar13. WOLLAEGER EE: Disturbances of gastrointestinal function following partial gastrectomy. Postgrad. Med. 8: 251, 1950. CrossrefMedlineGoogle Scholar14. TYORRUFFIN MPJM: The effect of prefeeding of fat on I-131 triolein absorption in subtotal gastrectomy patients. Proc. Soc. Exp. Biol. Med. 99: 61, 1958. CrossrefMedlineGoogle Scholar15. BOHMANSSON G: Prophylaxis and therapy in late postgastrectomy complications. Acta Med. Scand. supp. 246, 1950. Google Scholar16. ADAMS JF: Postgastrectomy megaloblastic anemia and the loop syndrome. Gastroenterologia (Basel) 89: 326, 1958. CrossrefMedlineGoogle Scholar17. NAISHCAPPER JWM: Intestinal cul-de-sac phenomena in man. Lancet 2: 597, 1953. CrossrefGoogle Scholar18. BUTLERCAPPERNAISH TJWMJM: Ileo-jejunal insufficiency following different types of gastrectomy. Gastroenterologia (Basel) 81: 104, 1954. CrossrefGoogle Scholar19. DAWSONISSELBACHER AMKJ: Studies on lipid metabolism in the small intestine with observations on the role of bile salts. J. Clin. Invest. 39: 730, 1960. CrossrefMedlineGoogle Scholar20. WIRTSGOLDSTEINCALARESUKRAMERCONCANNON CWFFRSJ: The Mechanism of Absorption of Radioactive Labeled Fat. Proceedings of the World Congress of Gastroenterology, 1958, The Williams & Wilkins Company, Baltimore, 1959, pp. 451-456. Google Scholar21. GOLDSTEINWIRTSKRAMER FCWS: The relationship of afferent limb stasis and bacterial flora to the production of postgastrectomy steatorrhea. Gastroenterology 40: 47, 1961. CrossrefMedlineGoogle Scholar22. SHAYCHEY HW: Personal communication. Google Scholar23. CHERRYCRANDALL ISLA: The specificity of pancreatic lipase: its appearance in the blood after pancreatic injury. Amer. J. Physiol. 100: 266, 1932. CrossrefGoogle Scholar24. BADENOCHEVANSRICHARDSWITTS JJRWCLJ: Megaloblastic anemia following partial gastrectomy and gastroenterostomy. Brit. J. Haemat. 1: 339, 1955. CrossrefMedlineGoogle Scholar25. MACLEAN LD: Incidence of megaloblastic anemia after subtotal gastrectomy. New Engl. J. Med. 257: 262, 1957. CrossrefMedlineGoogle Scholar26. STARZLBUTZHARTMAN TEGWCF: The blind-loop syndrome after gastric operations. Surgery 50: 849, 1961. MedlineGoogle Scholar27. DREXLER J: Effect of indole compounds on vitamin B-12 utilization. Blood 13: 239, 1958. CrossrefMedlineGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAuthors: C. WILMER WIRTS, M.D., F.A.C.P.; FRANZ GOLDSTEIN, M.D.Affiliations: Philadelphia, PennsylvaniaFrom the Department of Medicine, Division of Gastroenterology, The Jefferson Medical College Hospital, Philadelphia, Pennsylvania.Presented at the Forty-third Annual Session of The American College of Physicians, Philadelphia, Pennsylvania, April 9-13, 1962.Supported by grant A2804 of the Institute of Arthritis and Metabolic Diseases of the National Institutes of Health, United States Public Health Service.Requests for reprints should be addressed to C. Wilmer Wirts, M.D., Department of Medicine, The Jefferson Medical College of Philadelphia, 1025 Walnut Street, Philadelphia 7, Pennsylvania. 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FROST, M.D.The Significance of Abnormal Bacterial Proliferation in the Gastrointestinal Tract after Gastric SurgeryAbnormal Bile-Salt Patterns and Intestinal Bacterial Overgrowth Associated with MalabsorptionpH and Concentration of Pancreatic Enzymes in Aspirates from the Human Duodenum during Digestion of a Standard MealNutritional studies in patients with dumping syndromeBacteria and the Gut [ Abridged ]Postgastrectomy blind loop syndromeOccurrence in Gastric Juice of Antibody to a Complex of Intrinsic Factor and Vitamin B 12Normal Viral and Bacterial Flora of the Human Small and Large IntestinePostgastrectomy malabsorptionPeroral Biopsy of the Small IntestinePostgastrectomy hypoproteinemiaThe Correction of Postgastrectomy Malabsorption Following a Jejunal Interposition OperationMalabsorption in the Blind Loop SyndromeSteatorrhoea in rats with an intestinal cul-de-sacLate Post-Gastrectomy SyndromesPeptic UlcerNormal Bacterial Populations of the Intestine and Their Relation to Intestinal FunctionNormal Bacterial Populations of the Intestine and Their Relation to Intestinal FunctionMalabsorptionDiarrhea and steatorrhea due to a large solitary duodenal diverticulum 1 January 1963Volume 58, Issue 1Page: 25-36KeywordsExcretionGastroenterology and hepatologyHospital medicineLipasesPostgastrectomyStatistical dataSurgeryTetracyclinesWeight gainWeight loss ePublished: 1 December 2008 Issue Published: 1 January 1963 PDF downloadLoading ...