Abu-Elmagd, K

Brown, M

Campbell, W

Furukawa, H

Hutson, W

Reyes, J

Starzl, TE

Todo, S

Tzakis, A

English

PubMed

Name not available

Abnormal gastric emptying after intestinal transplantation

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,---------------------------_._--Abnormal Gastric Emptying After Intestinal Transplantation H. Furukawa, M. Brown. K. Abu-Elmagd, W. Hutson. W. Campbell. J. Reyes. A. Tzakis, S. Todo, and T.E. Starzl BASED on our clinical experience. abnormal gastnc emptying was suspected in some of the intestinal allograft recIpients. This event was partially confirmed by the conventional barium series.' In this study. scinti-graphic technique was utilized to evaluate the degree of the gastric emptying in the intestinal transplant patients. whether the stomach was native or part of the transplanted graft. 2.3 MATERIALS AND METHODS Gastric emptYing studies were performed In 13 adult intestinal transplant recIpients (7 men and II women) from September 1992 to October 1993. Of the 13 patients. 5 pallents received "olated small bowel grafts (SBl. 3 received combined liver and small bowel grafts (SB/Ll. and 5 received multi visceral grafts (MY l. which contained liver. pancreas. stomach. duodenum. and intes-tine. The test was performed 14 days to 2 years from the time of transplantallon. with a median of 4 months. In five patients the test was repeated twice over time. The patient fasted overnight and drugs known to influence gastrointestinal motility were stopped 24 hours prior to the study. A total of 18 liquid tests and 18 solid tests were performed on separate days. For the liquid test the patients were given 250 mL of Gatorade containing 0.5 mCi of Tc 99m. The amount of isotope remaining in the stomach was determmed every mmute for 60 minutes using a gamma camera. For the solid test the patients were given a standard meal consistmg of I oz of roast beef or chicken breast. 3 oz of Eggbeaters. I slice of white toast. 8 oz of skim milk. marganne. and jelly. which provide 17 g of protein. 10 g of fat. and 35.5 g of carbohydrate With 300 total calories. The Eggbeater contamed 1.0 mCi ofTc 99m sulfur colloid. The amount of isotope remalnmg in the stomach was determined every 15 to 20 mmutes for 6U mmutes. and then every 30 minutes for 2 hours. For hoth tests. the half life (T'!,) of the meal in the stomach was calculated. RESULTS SB recipients showed delayed gastric emptying in 40% of the liquid and 20% of the solid studies (Table I). SB/L recipients showed delayed gastric emptying in 66% of the liquid and 33% of the solid studies. The gastric emptying study that was repeated 6 months later in one of the SB/L recipients graft showed improvement of both the liquid and solid gastric emptying tests. MY patients showed abnor-1634 Table 1. Gastric Emptying in Intestinal Transplantation Recipients T1a in uQu,d Study T1,2 In Solid Study Normal Delayed RaPid Normal Delayed RaPid SB 3 2 0 4 0 SB/L 1 2 0 2 1 0 MV 4 0 0 1 3 Total 8 4 6 3 3 mal gastric emptying in 20% of the liquid and 100% of the solid studies. Fast gastric emptying was persistent in one of the MY recipients up to 18 months after surgery. DISCUSSION Delayed gastric emptying was observed in 38% of the intestinal allograft recipients studied. which improved over time in some of the serially studied cases. The underlying cause of such morbid events could be related to gut denervation or disturbance of the enteric hormones. In MY recipients. the allograft stomach. with pyloroplasty or pyloromyotomy. may explain the high incidence of rapid gastric emptying. Further studies are certainly required to identify the exact mechanism of these observations. which may help to improve the clinical management of these unique intestinal allograft recipients. REFERENCES 1. Campbell W. Abu-Elmagd K. Federle M: Am J Roentogen lin press) 2. Minami H. McCallum RW: Gastroenterology 86:1592. 1984 3. Malmud LS. Fisher RS. Knight LC. et al: Semm Nucl Med 7:116.1982 From the Pittsburgh Transplantation Institute. UniverSity of Pitts-burgh Medical Center, Pittsburgh, Pennsylvania. Address reprint requests to Satoru Todo. MD, Pittsburgh Trans-plantation Institute, 5C Falk CliniC. 3601 Fifth Avenue. Pittsburgh, PA 15213. ~I 1994 by Appleton & Lange 0041-1345/941 $3.001 + 0 Transplantation Proceeclngs. Vol 26. No 3 (June). 1994: p 1634 

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Abnormal gastric emptying after intestinal transplantation

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