The different components of gastric emptying after gastric surgery.

Gastric emptying of liquid and solid meals was studied before and after operation in 22 male patients who were admitted to a prospective randomized trial of truncal vagotomy and antrectomy and proximal gastric vagotomy in the treatment of duodenal ulceration. After operation the emptying of both solid and liquid meals was biphasic, with a passive early phase and a later controlled active phase. A significant increase in early liquid emptying was produced by both operations, and after truncal vagotomy and antrectomy also with the solid meal. Active emptying of the liquid meals was unaffected by either operation, but both operations significantly prolonged the active emptying of the solid meals. The clinical symptoms of dumping were related to rapid early liquid emptying (cascading) and those of gastric retention were related to delayed active emptying of the solid meal. These findings explain how the same operation can produce the opposing symptom complexes of dumping and gastric retention and how both sets of symptoms can occur in the same individual.