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Background/aims: The gastrointestinal symptoms accompanying dysfunction of the remnant stomach were seen after pylorus-preserving operation. Against such complications, Dai-kenchu-to (DKT) is used, but scientific evidences for efficacy are poor. The effect of DKT on gastrointestinal motility and gastric emptying after pylorus-preserving operation was investigated., Methods: Using beagle dogs, the experimental models mimicking the state after pylorus-preserving pancreaticoduodenectomy were prepared. We sutured strain gauge transducers to the stomach, duodenum and jejunum and inserted indwelling tubes into the stomach. About 4 weeks after operation, DKT 0.1g/kg was administered during the fasting or fed state. At the same time, the gastric emptying was evaluated by the acetoaminophene method., Results: In the fasting state, administration of DKT enhanced the gastrointestinal motility and accelerated gastric emptying. In the postprandial state, no apparent effect on motility was seen., Conclusion: DKT enhances the gastrointestinal motility after pylorus-preserving pancreaticoduodenectomy in the fasting state. The effect of DKT may not be related to the continuity of the intramural nerve.

Purpose: The efficacy of enteral nutrition in postoperative nutritional management is known, but the effects on gastrointestinal motility and nutrition have not yet been elucidated. The purpose of this study was to compare the effects of enteral and parenteral nutrition soon after open abdominal surgery on gastrointestinal motility and nutritional status., Methods: A partial resection of rectum models was prepared to compare two types of nutrient administration: enteral nutrition and total parenteral nutrition. The differences between the effects of nutrition types in terms of gastrointestinal motility and nutritional status were investigated., Results: Enteral nutrition contributed to recovery of gastrointestinal motility and maintenance of nutritional status., Conclusion: Enteral nutrition should therefore be initiated soon after surgery if the gastrointestinal tract is available.

After major abdominal surgery, postoperative ileus is inevitable, and it has always been a challenge for the surgical team to shorten the duration of this period. Based on many clinical and basic reports that affirm the effect on the recovery of gastrointestinal motility, epidural analgesia has been used widely to promote recovery from postoperative ileus. Different techniques have been used to measure gastrointestinal motility in laboratory and clinical investigations. Many of the techniques used in clinical investigations of gastrointestinal motility are controversial because they are subjective. In the laboratory strain gauge force transducer (SGT) can provide objective data on gastrointestinal motility. Nevertheless the significance of SGT in the clinical setting is yet to be confirmed. Therefore in this review we examine both clinical and laboratory outcomes of epidural analgesia on gastrointestinal motility to present the possibility for the development of gastrointestinal motility research with SGTs. We suggest that further investigation using SGTs may lead to the development of objective methods that allow objective assessment of post-surgical gastrointestinal function.

The purpose of this study was to investigate the effects of the herbal medicine dai-kenchu-to on gastrointestinal motility based on differences in the administration site and timing. We sutured strain-gauge transducers to the stomach (three), duodenum (one), jejunum (one), ileum (one), and colon (two) and inserted indwelling tubes into the stomach, jejunum, and proximal colon of beagles. Dai-kenchu-to was administered to each site during the fasting or fed state. During the fasting state, the prokinetic effects of dai-kenchu-to were evident at all administration sites. The effects were attenuated during the fed state. With intracolonic administration, a contraction similar to the giant migrating contraction-like contraction was induced during the fasting and the fed state, and defecation occurred. Despite the differences in administration site and timing, no contraction complex appeared orad to the administration sites. These results indicate that the prokinetic effects of dai-kenchu-to differ with the site or timing of administration.

Effects of various histamine H2-receptor antagonists (H2-RA) on gastrointestinal motility and gastric emptying were investigated. Ranitidine, nizatidine and cimetidine dose dependently induced contractions over the entire gastrointestinal tract, and the order of their effects was ranitidine > nizatidine > cimetidine. Roxatidine or famotidine had no effects on motility of the gastrointestinal tract. Ranitidine and nizatidine also induced contractions during the postprandial period and facilitated gastric emptying, while cimetidine, roxatidine or famotidine did not influence gastric emptying. Since acid reduction is thought to be the most important element of the treatment of peptic ulcer and reflux esophagitis, it was inferred that administration of a H2-RA selected with consideration of its property of facilitating gastrointestinal motility is effective in the treatment of patients with abnormal gastrointestinal motility.

The motor activity of the canine lower esophageal sphincter (LES) was studied under conscious states by means of the strain gage transducer, and gastroesophageal reflux was investigated after injection of the contrast medium through the silastic tube inserted in gastric fundus by x-ray. The motor activity and function of LES were observed in the dogs with selective proximal vagotomy (SPV), truncal vagotomy (TV) and TV + gastrectomy. Results were summarized as follows; 1. In the postprandial period, so called receptive relaxation was observed in gastric body, and tonic contraction was observed in LES. On the other hand, the occurrence of the LES contraction was consistent with gastric periodic motor activity in the interdigestive state. It was found that such a contractile pattern of LES and gastric body prevented the reflux of gastric juice from stomach to esophagus in the digestive and interdigestive state. 2. In the postprandial period, the tonic contraction of LES was inhibited by the venous injection of atropine sulfate. Mechanisms of digestive contractile activity of LES were mainly regulated by cholinergic nerve. 3. After SPV and TV, the motility of LES and gastric body was disturbed. Namely, receptive relaxation disappeared, and tonic contraction was observed in gastric body, but the relaxation of the LES was found after ingestion. These findings suggested that discordant LES contractiles with the contraction of the gastric body after vagotomy produced a gastroesophageal reflux. 4. After TV + gastrectomy, the synchronous motor activity of the LES, remnant stomach and duodenum disappeared. Namely, it was thought that the reflux esophagitis occurred after gastric surgery with vagotomy and lymphnodes dissection was caused by the duodenal juice reflux to remnant stomach and esophagus.

Using adult mongrel dogs, gastroduodenal motility, gastric emptying and pertinent serum motilin levels were measured under conscious states before and after transthoracic truncal vagotomy. Gastroduodenal motility was recorded by chronically planted strain gage transducers along the gastrointestinal tract. Gastric emptying was measured by X-ray examinations after barium-meat-meal ingestions or by gastric contents sampling method through the total pouch cannula after normal dog food ingestions. Results were as follows; Gastric motility patterns recorded by strain gage transducers were classified into two patterns that were a digestive pattern (D.P.) and an interdigestive pattern (I.P.). Serum motilin levels were elevated during high-amplitude contractions and lowered during resting phase of interdigestive periods. After vagotomy, strengths (heights) of antral contractions and phasic changes were decreased with the lack of I.P. These postvagotomy changes were thought to be related with the delayed gastric emptying after vagotomy. Gastric lavage through the cannula or pyloroplasty produced no effect on recovery of I.P. This fact suggested that the lack of I.P. was the direct effect of vagotomy and not due to delayed gastric contents emptying. On the assumption that motilin had the major role on the regulation of I.P., vagotomy seemed to produce an effect to prevent phasic motilin release.

Unlabelled: Serum gastrin changes before and after selective proximal vagotomy (SPV) were studied in relation to the gastric motility and the acid secretion clinically and experimentally and the effects of pyloroplasty were investigated., Results and Conclusions: Experimental studies revealed that test meals provoked gastrin secretion to stimulate gastric motility. Periodical gastric acid secretions were observed during hunger period, along with elevated serum gastrin levels. After SPV, gastrin responses to the test meals were significantly increased so that the pyloric ring motility was disturbed. Clinical studies revealed that adrenaline infusion test provoked significant gastrin responses to secrete acid secretions in duodenal ulcer patients. After SPV, increased gastrin responses to adrenaline restored acid secretions as much as preoperative acid secretions responded to the adrenaline test. Pyloroplasty for the SPV inhibited the gastrin and acid secretions responded to the adrenaline test.