Postgastrectomy pancreatic malabsorption: is there a case for intervention?

More patients are surviving surgery for gastric carcinoma than ever before. The possible causes of malabsorption following total gastrectomy are multifactorial, and pancreatic insufficiency has been proposed as one mechanism. Other contributing factors include loss of gastric reservoir, rapid small bowel transit, small bowel bacterial overgrowth and the type of operation performed. Although pancreatic exocrine insufficiency has been demonstrated after gastrectomy, the key question remains whether pancreatic enzyme supplements offer any substantial clinical benefit to the patient. The evidence to date does not support the routine use of pancreatic enzyme supplementation after gastrectomy.