Postprandial plasma secretin response in patients following gastrectomy

Endogenous secretin release and luminal pH changes after a test meal were investigated in five normal persons and in 22 patients after gastrectomy and various anatomic reconstructions, such as Billroth I and II anastomoses after subtotal gastrectomy and Roux-en-Y and interposed jejunal anastomosis after total gastrectomy. In patients in the Billroth I group, the response of postprandial secretin was good if the duodenal pH was below 4.5 but it was less than that of normal persons. After the Billroth II operation, even when the jejunal pH was below 4.0, the response was much less than that for the Billroth I group. After the complete abolishment of gastric acid secretion by total gastrectomy, no postprandial secretin response was noted in patients with the Roux-en-Y anastomosis. However, a response was seen in patients with interposed jejunal anastomosis, even though it was less than that for those in the Billroth I group and in normal persons. We conclude that the impairment of endogenous secretin release may be an important factor in pancreatic dysfunction after gastrectomy, and we 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-en-Y anastomoses to obtain endogenous secretin release.