Relief of acute, persistent postvagotomy atony by metoclopramide

Seventeen patients with acute, persistent postvagotomy atony after vagotomy with antrectomy or pyrloroplasty for peptic ulcer underwent a doubleblind study of the relief of postvagotomy atony by metoclopramide. All patients had complete, functional gastric obstruction for at least three weeks postoperatively, precluding oral alimentation. Contrast studies and gastroscopy ruled out mechanical obstruction in each patient. Gastric outlet obstruction was confirmed by radioisotope assessment of gastric emptying of a special solid meal labeled with Technetium 99m DTPA. A gamma camera over the epigastrium precisely quantitated the emptying rate of the labeled meals. After baseline scanning an intravenous placebo was given to each patient and all 17 showed gastric retention of the meal after 90 minutes. Gastric emptying rates were restudied 24 hours later after intravenous metoclopramide and all 17 patients then immediately emptied the labeled meals. These patients then received standard postgastrectomy diets. Eight patients received metoclopramide tablets (10 mg 30 minutes a.c., q.i.d.) and nine received placebo tablets. Each of the eight patients receiving metoclopramide ate normally immediately after treatment with no further evidence of gastric atony. The nine patients receiving the placebo were unable to retain any oral feedings and were then given oral metoclopramide which promptly relieved gastric atony. All 17 patients received metoclopramide for one month without side effects after which the drug was discontinued with no recurrence of gastric symptoms during follow-up periods ranging from three to 27 months. Metoclopramide safely and effectively relieves acute, nonmechanical gastric atony when this occurs after surgical treatment of peptic ulcer.