[Postprandial plasma secretin concentration and luminal pH in patients with gastrectomy]

The plasma secretin concentration in response to a meat meal and luminal pH were investigated in patients with gastrectomy: total gastrectomy with Roux-Y anastomosis or interposed jejunal anastomosis and partial gastrectomy with Billroth I or Billroth II anastomosis. The fasting plasma secretin concentration was significantly elevated in relation to the decreases of duodenal pH in postprandial state in normal subjects. No significant response of the plasma secretin and jejunal pH were observed in patients with total gastrectomy with Roux-Y anastomosis, however total gastrectomized patients with jejunal interposition showed the peak plasma secretin response in postprandial state. In patients with Billroth I the postprandial plasma secretin concentrations were well responded when the duodenal pH was below 4.5, however it was less than that of normal subjects. In patients with Billroth II the response of plasma secretin was much less than that of Billroth I, even though the decrease of jejunal pH was as comparable as in Billroth I. These studies suggest that a Billroth I operation after subtotal gastrectomy and interposed jejunal anastomosis after total gastrectomy are better procedures than the Billroth II or Roux-Y anastomoses to obtain endogenous secretin release.