[Previous history of gastrectomy in the aged: a malnutrition with malignant aspect]

Between 1979 and 1986 a prospective study was performed on 15 gastrectomized (Billroth II) patients, who were above 65 years old, with evidence of clinical malnutrition as defined by anthropometric criteria. Gastrectomy had been performed between 2 and 55 years before the study (29 +/- 12.87 years). In twelve patients weight loss was observed ranging from 5.85 and 11.91 kg in a mean period of 12.7 months immediately prior to admission. In 8 cases the initial diagnosis was of malignancy, in 2 cases of severe anemia, and in 1 case of severe malnutrition. Intestinal malabsorption (IMB) was observed in 5 cases and intestinal bacterial overgrowth (IBO) in 2 cases, and both diagnosis in 4 cases using stool fat test and D-xylose test for the diagnosis of IMB and urine determination of Urican for the diagnosis of IBO. In two patients the test were normal and they could not be performed in two other. In 3 patients malignancy could not be observed however one of them presented IMB and the other IMB and IBO. We conclude that gastrectomy when performed in earlier ages can cause malnutrition at an older age, provoking a sudden malnutrition suggestive of malignancy. Most of these patients present IMB and/or IBO. Since IBO can cause irreversible mucosal damage, it is discussed whether this could be the cause of this clinical picture.