Stomach cancer is the most common cause of cancer death in Korea and there is increasing tendency towards total gastrectomy as the treatment for stomach cancer. Malnutrition after total gastrectomy has been regarded as a necessory consequence.
Although
nutritional status is an indicator which can influence individuals immunologic function, morbidity and quality of life, there are few reports about the nutritional status and malabsorption study of total gastrectomized patients with loop
esophagojejunostomy the most common method of reconstruction in Korea.
This study was performed to access the nutritional status and to look at the results of malabsorption tests of total gastrectomized patients who had had immunochemotheraphy for two years and had no evidence of recurrence or underlying metabolic
diseases. Nutritional status was assessed by anthropometric methods and serologic measurement. Malabsorption tests were done to discriminate causes of malnutrition after total gastrectomy and included fecal fat excretion test, d-xylose absorption
test,
glucose tolerance test, vitamin B12 absorption test, culture of jejunal aspirates and jejunal biopsy.
Results showed that the average weight loss was fifteen percent of preoperative weight. Skeletal protein and visceral protein malnutrition was not found. There was severe fat malnutrition and a deficit of total body fat. Postoperative body mass
index
showed significant changes when compared to preoperative body mass index.
In the malabsorption tests, the daily excreted amount of fecal fat was 28.56±3.35gm (Mean±S.E), which indicated fat malabsorption of carbohydrate. Vitamin B12 absorption test revealed abnormal findings in sixty four percent of the total
gastrectomized
patients. The serum concentration of vitamin B12 was lower in seventy one percent of the studied group when compared to the normal group, and this was found to be related to the malabsorption of vitamin B12. Bacterial overgrowth was not found and
there
were no specific findings on microscopic examination of the jejunal mucosa.
In conclusion, poor oral intake and relative pancreatic insufficiency were considered as the possible causes of malnutrition after total gastrectomy.
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