Tonic motor activity of the narrow gastric tube used as an oesophageal substitute.

摘要

OBJECTIVE: To assess the compliance, the existence of basal tone, the sensory response to distension, and the integrity of the neurohumoral enterogastric inhibitory reflex of the narrow gastric tube as an oesophageal substitute. DESIGN: Explanatory experimental study. SETTING: University hospital, The Netherlands. PATIENTS: Eight patients after oesophagectomy, formation of a narrow gastric tube, and cervical gastro-oesophagostomy. INTERVENTIONS: Measurements of intragastric tonic motor activity with a Barostat. MAIN OUTCOME MEASUREMENTS: Compliance, sensations during stepwise pressure increments, and changes in tone induced by glucagon and intraduodenal feeding. RESULTS: The compliance of the narrow gastric tube was found to be low (median 13.5 ml/mmHg (range 5-21)). Most of the patients perceived minimal sensation on distension. All patients had phasic tonic contractions during distension of the gastric tube. The median (range) relaxation after glucagon had been given intravenously was 14 ml (range 3-57) (p < 0.05). The tonic reaction to nutrients in the duodenum was not significant. CONCLUSIONS: The compliance of the narrow gastric tube is low. Postprandial symptoms are not caused by distension of the proximal part of the narrow gastric tube. Basal gastric tone and phasic activity were at least partially restored over time after operation. The enterogastric inhibitory reflex is eliminated by oesophageal resection and reconstruction of a gastric tube.