Effects of gastric surgery upon gastric emptying in cases of peptic ulceration.

Alteration in the rate of gastric emptying has long been considered responsible for many of the sequelae of gastric surgery. For example, rapid gastric emptying after gastroenterostomy (Hertz, 1913; Mix, 1922) or Polya gastrectomy (Johnson, 1954; Abbott, Krieger, and Levey, 1958) can cause one type of 'dumping syndrome'. Delayed post-gastrectomy emptying may also cause problems (Snell, 1937; Hosford, 1949). Dragstedt treated duodenal ulcers with vagotomy, but the resulting gastric stasis was associated with a high incidence of gastric ulceration (Dragstedt, Camp, and Fritz, 1949). It was this observation that led them to believe that almost all gastric ulcers were caused by antral overactivity associated with gastric stasis. Several workers have studied gastric emptying in the early post-operative period using either radiological (Abbott et al., 1958; Rothnie, Harper, and Catchpole, 1963; Well's Tinckler, Rawlinson, Jones, and Saunders, 1964) or pressure balloon (Goodall, 1964) records. However, the late effects of gastric surgery on gastric emptying have been rarely studied (Roth, Vilardell, and Affolter, 1962; Butler, 1964; Goodall, 1966). This work was carried out in an attempt to correct this deficiency in our knowledge, and also to test the validity of the theory that gastric stasis causes gastric ulceration.